Deflectable support of RF energy electrode with respect to opposing ultrasonic blade

ABSTRACT

An end-effector is disclosed. The end-effector includes a clamp arm and an ultrasonic blade configured to acoustically couple to an ultrasonic transducer and electrically couple to a pole of an electrical generator. The clamp arm includes a clamp jaw, a clamp arm pad, and a cantilever electrode that is free to deflect. The cantilever electrode is configured to electrically couple to an opposite pole of the electrical generator. Also disclosed are configurations where the clamp arm includes a peripheral cantilever electrode and a clamp arm pad extending beyond the electrode, a floating cantilever electrode and a resilient clamp arm pad, an interlocked cantilever electrode plate and a clamp arm pad configured to receive the plate, a laterally deflectable cantilever electrode and a clamp arm pad extending beyond the electrode, and a flexible cantilever electrode and a clamp arm pad extending beyond the electrode.

CROSS-REFERENCE TO RELATED APPLICATION

The present application claims priority under 35 U.S.C. § 119(e) to U.S. Provisional Patent Application Ser. No. 62/955,292, titled COMBINATION ENERGY MODALITY END-EFFECTOR, filed Dec. 30, 2019, the disclosure of which is herein incorporated by reference in its entirety.

TECHNICAL FIELD

The present disclosure generally relates to end-effectors adapted and configured to operate with multiple energy modalities to enable tissue sealing and cutting employing simultaneously, independently, or sequentially applied energy modalities. More particularly, the present disclosure relates to end-effectors adapted and configured to operate with surgical instruments that employ combined ultrasonic and electrosurgical systems, such as monopolar or bipolar radio frequency (RF), to enable tissue sealing and cutting employing simultaneously, independently, or sequentially applied ultrasonic and electrosurgical energy modalities. The energy modalities may be applied based on tissue parameters or other algorithms. The end-effectors may be adapted and configured to couple to hand held or robotic surgical systems.

BACKGROUND

Ultrasonic surgical instruments employing ultrasonic energy modalities are finding increasingly widespread applications in surgical procedures by virtue of the unique performance characteristics of such instruments. Depending upon specific instrument configurations and operational parameters, ultrasonic surgical instruments can provide substantially simultaneous cutting of tissue and hemostasis by coagulation, desirably minimizing patient trauma. The cutting action is typically realized by an end-effector, ultrasonic blade, or ultrasonic blade tip, at the distal end of the instrument, which transmits ultrasonic energy to tissue brought into contact with the end-effector. An ultrasonic end-effector may comprise an ultrasonic blade, a clamp arm, and a pad, among other components.

Some surgical instruments utilize ultrasonic energy for both precise cutting and controlled coagulation. Ultrasonic energy cuts and coagulates by vibrating a blade in contact with tissue. Vibrating at high frequencies (e.g., 55,500 times per second), the ultrasonic blade denatures protein in the tissue to form a sticky coagulum. Pressure exerted on tissue with the blade surface collapses blood vessels and allows the coagulum to form a hemostatic seal. The precision of cutting and coagulation is controlled by the surgeon's technique and adjusting the power level, blade edge, tissue traction, and blade pressure.

Electrosurgical instruments for applying electrical energy modalities to tissue to treat, seal, cut, and/or destroy tissue also are finding increasingly widespread applications in surgical procedures. An electrosurgical instrument typically includes an instrument having a distally-mounted end-effector comprising one or more than one electrode. The end-effector can be positioned against the tissue such that electrical current is introduced into the tissue. Electrosurgical instruments can be configured for bipolar or monopolar operation. During bipolar operation, current is introduced though a first electrode (e.g., active electrode) into the tissue and returned from the tissue through a second electrode (e.g., return electrode). During monopolar operation, current is introduced into the tissue by an active electrode of the end-effector and returned through a return electrode such as a grounding pad, for example, separately coupled to the body of a patient. Heat generated by the current flowing through the tissue may form hemostatic seals within the tissue and/or between tissues and thus may be particularly useful for sealing blood vessels, for example. The end-effector of an electrosurgical instrument also may include a cutting member that is movable relative to the tissue and the electrodes to transect the tissue. Electrosurgical end-effectors may be adapted and configured to couple to hand held instruments as well as robotic instruments.

Electrical energy applied by an electrosurgical instrument can be transmitted to the instrument by a generator in communication with the hand piece. The electrical energy may be in the form of radio frequency (“RF”) energy. RF energy is a form of electrical energy that may be in the frequency range of 200 kilohertz (kHz) to 1 megahertz (MHz). In application, an electrosurgical instrument can transmit low frequency RF energy through tissue, which causes ionic agitation, or friction, in effect resistive heating, thereby increasing the temperature of the tissue. Because a sharp boundary is created between the affected tissue and the surrounding tissue, surgeons can operate with a high level of precision and control, without sacrificing un-targeted adjacent tissue. The low operating temperatures of RF energy is useful for removing, shrinking, or sculpting soft tissue while simultaneously sealing blood vessels. RF energy works particularly well on connective tissue, which is primarily comprised of collagen and shrinks when contacted by heat.

The RF energy may be in a frequency range described in EN 60601-2-2:2009+A11:2011, Definition 201.3.218—HIGH FREQUENCY. For example, the frequency in monopolar RF applications may be typically restricted to less than 5 MHz. However, in bipolar RF energy applications, the frequency can be almost anything. Frequencies above 200 kHz can be typically used for monopolar applications in order to avoid the unwanted stimulation of nerves and muscles that would result from the use of low frequency current. Lower frequencies may be used for bipolar applications if the risk analysis shows the possibility of neuromuscular stimulation has been mitigated to an acceptable level. Normally, frequencies above 5 MHz are not used in order to minimize the problems associated with high frequency leakage currents. Higher frequencies may, however, be used in the case of bipolar applications. It is generally recognized that 10 mA is the lower threshold of thermal effects on tissue.

Ultrasonic surgical instruments and electrosurgical instruments of the nature described herein can be configured for open surgical procedures, minimally invasive surgical procedures, or non-invasive surgical procedures. Minimally invasive surgical procedures involve the use of a camera and instruments inserted through small incisions in order to visualize and treat conditions within joints or body cavities. Minimally invasive procedures may be performed entirely within the body or, in some circumstances, can be used together with a smaller open approach. These combined approaches, known as “arthroscopic, laparoscopic or thoracoscopic-assisted surgery,” for example. The surgical instruments described herein also can be used in non-invasive procedures such as endoscopic surgical procedures, for example. The instruments may be controlled by a surgeon using a hand held instrument or a robot.

A challenge of utilizing these surgical instruments is the inability to control and customize single or multiple energy modalities depending on the type of tissue being treated. It would be desirable to provide end-effectors that overcome some of the deficiencies of current surgical instruments and improve the quality of tissue treatment, sealing, or cutting or combinations thereof. The combination energy modality end-effectors described herein overcome those deficiencies and improve the quality of tissue treatment, sealing, or cutting or combinations thereof.

SUMMARY

In one aspect, an apparatus is provided for dissecting and coagulating tissue. The apparatus comprises a surgical instrument comprising an end-effector adapted and configured to deliver a plurality of energy modalities to tissue at a distal end thereof. The energy modalities may be applied simultaneously, independently, or sequentially. A generator is electrically coupled to the surgical instrument and is configured to supply a plurality of energy modalities to the end-effector. In one aspect, the generator is configured to supply electrosurgical energy (e.g., monopolar or bipolar radio frequency (RF) energy) and ultrasonic energy to the end-effector to allow the end-effector to interact with the tissue. The energy modalities may be supplied to the end-effector by a single generator or multiple generators.

In various aspects, the present disclosure provides a surgical instrument configured to deliver at least two energy types (e.g., ultrasonic, monopolar RF, bipolar RF, microwave, or irreversible electroporation [IRE]) to tissue. The surgical instrument includes a first activation button for activating energy, a second button for selecting an energy mode for the activation button. The second button is connected to a circuit that uses at least one input parameter to define the energy mode. The input parameter can be modified remotely through connection to a generator or through a software update.

In one aspect, the present disclosure provides a combination ultrasonic/bipolar RF energy surgical device. The combination ultrasonic/bipolar RF energy surgical device comprises an end-effector. The end-effector comprises a clamp arm and an ultrasonic blade. The clamp arm comprises a movable clamp jaw, a compliant polymeric pad, and at least one bipolar RF electrode. The at least one electrode is coupled to a positive pole of an RF generator and the ultrasonic blade is coupled to the negative pole of the RF generator. The ultrasonic blade is acoustically coupled to an ultrasonic transducer stack that is driven by an ultrasonic generator. In one aspect, the at least one electrode acts a deflectable support with respect to an opposing ultrasonic blade. The at least one electrode crosses over the ultrasonic blade and is configured to be deflectable with respect to the clamp arm having features to change the mechanical properties of the tissue compression under the at least one electrode. The at least one electrode includes a feature to prevent inadvertent contact between the electrode and the ultrasonic blade.

In another aspect, the present disclosure provides a combination ultrasonic/bipolar RF energy surgical device. The combination ultrasonic/bipolar RF energy surgical device comprises an end-effector. The end-effector comprises a clamp arm and an ultrasonic blade. The clamp arm comprises a movable clamp jaw, a compliant polymeric pad, and at least one bipolar RF electrode. The at least one electrode is coupled to a positive pole of an RF generator and the ultrasonic blade is coupled to the negative pole of the RF generator. The ultrasonic blade is acoustically coupled to an ultrasonic transducer stack that is driven by an ultrasonic generator. In one aspect, the movable clamp jaw comprises at least one non-biased deflectable electrode to minimize contact between the ultrasonic blade and the RF electrode. The ultrasonic blade pad contains a feature for securing the electrode to the pad. As the pad height wears or is cut through, the height of the electrode with respect to the clamp jaw is progressively adjusted. Once the clamp jaw is moved away from the ultrasonic blade, the electrode remains in its new position.

In another aspect, the present disclosure provides a combination ultrasonic/bipolar RF energy surgical device. The combination ultrasonic/bipolar RF energy surgical device comprises an end-effector. The end-effector comprises a clamp arm and an ultrasonic blade. The clamp arm comprises a movable clamp jaw, a compliant polymeric pad, and at least one bipolar RF electrode. The at least one electrode is coupled to a positive pole of an RF generator and the ultrasonic blade is coupled to the negative pole of the RF generator. The ultrasonic blade is acoustically coupled to an ultrasonic transducer stack that is driven by an ultrasonic generator. In one aspect, the at least one bipolar RF electrode is deflectable and has a higher distal bias than proximal bias. The bipolar RF electrode is deflectable with respect to the clamp jaw. The end-effector is configured to change the mechanical properties of the tissue compression proximal to distal end to create a more uniform or differing pattern of pressure than due to the clamping alone.

In another aspect, the present disclosure provides a combination ultrasonic/bipolar RF energy surgical device. The combination ultrasonic/bipolar RF energy surgical device comprises an end-effector. The end-effector comprises a clamp arm and an ultrasonic blade. The clamp arm comprises a movable clamp jaw, a compliant polymeric pad, and at least one bipolar RF electrode. The at least one electrode is coupled to a positive pole of an RF generator and the ultrasonic blade is coupled to the negative pole of the RF generator. The ultrasonic blade is acoustically coupled to an ultrasonic transducer stack that is driven by an ultrasonic generator. In one aspect, the bipolar RF electrode is deflectable and the end-effector provides variable compression/bias along the length of the deflectable electrode. The end-effector is configured to change the mechanical properties of the tissue compression under the electrodes based on clamp jaw closure or clamping amount.

In another aspect, the present disclosure provides a combination ultrasonic/bipolar RF energy surgical device. The combination ultrasonic/bipolar RF energy surgical device comprises an end-effector. The end-effector comprises a clamp arm and an ultrasonic blade. The clamp arm comprises a movable clamp jaw, a compliant polymeric pad, and at least one bipolar RF electrode. The at least one electrode is coupled to a positive pole of an RF generator and the ultrasonic blade is coupled to the negative pole of the RF generator. The ultrasonic blade is acoustically coupled to an ultrasonic transducer stack that is driven by an ultrasonic generator. The one aspect, the pad includes asymmetric segments to provide support for the ultrasonic blade support and the electrode is movable. The asymmetric segmented pad is configured for cooperative engagement with the movable bipolar RF electrode. The segmented ultrasonic support pad extends at least partially through the bipolar RF electrode. At least one pad element is significantly taller than a second pad element. The first pad element extends entirely through the bipolar RF electrode and the second pad element extends partially through the bipolar RF electrode. The first pad element and the second pad element are made of dissimilar materials.

In another aspect, the present disclosure provides a combination ultrasonic/bipolar RF energy surgical device. The combination ultrasonic/bipolar RF energy surgical device comprises an end-effector. The end-effector comprises a clamp arm and an ultrasonic blade. The clamp arm comprises a movable clamp jaw, a compliant polymeric pad, and at least one bipolar RF electrode. The at least one electrode is coupled to a positive pole of an RF generator and the ultrasonic blade is coupled to the negative pole of the RF generator. The ultrasonic blade is acoustically coupled to an ultrasonic transducer stack that is driven by an ultrasonic generator. In one aspect, variations in the physical parameters of the electrode in combination with a deflectable electrode are employed to change the energy density delivered to the tissue and the tissue interactions. The physical aspects of the electrode vary along its length in order to change the contact area and/or the energy density of the electrode to tissue as the electrode also deflects.

In another aspect, the present disclosure provides a combination ultrasonic/bipolar RF energy surgical device. The combination ultrasonic/bipolar RF energy surgical device comprises an end-effector. The end-effector comprises a clamp arm and an ultrasonic blade. The clamp arm comprises a movable clamp jaw, a compliant polymeric pad, and at least one bipolar RF electrode. The at least one electrode is coupled to a positive pole of an RF generator and the ultrasonic blade is coupled to the negative pole of the RF generator. The ultrasonic blade is acoustically coupled to an ultrasonic transducer stack that is driven by an ultrasonic generator. In one aspect, an ultrasonic transducer control algorithm is provided to reduce the power delivered by the ultrasonic or RF generator when a short circuit of contact between the ultrasonic blade and the electrode is detected to prevent damage to the ultrasonic blade. The ultrasonic blade control algorithm monitors for electrical shorting or ultrasonic blade to electrode contact. This detection is used to adjust the power/amplitude level of the ultrasonic transducer when the electrical threshold minimum is exceeded and adjusts the transducer power/amplitude threshold to a level below the minimum threshold that would cause damage to the ultrasonic blade, ultrasonic generator, bipolar RF electrode, or bipolar RF generator. The monitored electrical parameter could be tissue impedance (Z) or electrical continuity. The power adjustment could be to shut off the ultrasonic generator, bipolar RF generator, of the surgical device or it could be a proportionate response to either the electrical parameter, pressure, or time or any combination of these parameters.

In another aspect, the present disclosure provides a combination ultrasonic/bipolar RF energy surgical device. The combination ultrasonic/bipolar RF energy surgical device comprises an end-effector. The end-effector comprises a clamp arm and an ultrasonic blade. The clamp arm comprises a movable clamp jaw, a compliant polymeric pad, and at least one bipolar RF electrode. The at least one electrode is coupled to a positive pole of an RF generator and the ultrasonic blade is coupled to the negative pole of the RF generator. The ultrasonic blade is acoustically coupled to an ultrasonic transducer stack that is driven by an ultrasonic generator. In one aspect, the clamp jaw features or aspects are provided in the clamp ram to minimize tissue sticking and improve tissue control. The clamp arm tissue path or clamp area includes features configured to adjust the tissue path relative to the clamp arm/ultrasonic blade to create a predefined location of contact to reduce tissue sticking and charring.

In another aspect, the present disclosure provides a combination ultrasonic/bipolar RF energy surgical device. The combination ultrasonic/bipolar RF energy surgical device comprises an end-effector. The end-effector comprises a clamp arm and an ultrasonic blade. The clamp arm comprises a movable clamp jaw, a compliant polymeric pad, and at least one bipolar RF electrode. The at least one electrode is coupled to a positive pole of an RF generator and the ultrasonic blade is coupled to the negative pole of the RF generator. The ultrasonic blade is acoustically coupled to an ultrasonic transducer stack that is driven by an ultrasonic generator. In one aspect, a partially conductive clamp arm pad is provided to enable electrode wear through and minimize electrical shorting between the ultrasonic blade and the bipolar RF electrode. The clamp arm pad includes electrically conductive and non-conductive portions allowing it to act as one of the bipolar RF electrodes while also acting as the wearable support structure for the ultrasonic blade. The electrically conductive portions of the clamp ram pad are positioned around the perimeter of the pad and not positioned directly below the ultrasonic blade contact area. The electrically conductive portion is configured to degrade or wear to prevent any contact with the ultrasonic blade from interrupting the electrical conductivity of the remaining electrically conductive pad.

In addition to the foregoing, various other method and/or system and/or program product aspects are set forth and described in the teachings such as text (e.g., claims and/or detailed description) and/or drawings of the present disclosure.

The foregoing is a summary and thus may contain simplifications, generalizations, inclusions, and/or omissions of detail; consequently, those skilled in the art will appreciate that the summary is illustrative only and is NOT intended to be in any way limiting. Other aspects, features, and advantages of the devices and/or processes and/or other subject matter described herein will become apparent in the teachings set forth herein.

In one or more various aspects, related systems include but are not limited to circuitry and/or programming for effecting herein-referenced method aspects; the circuitry and/or programming can be virtually any combination of hardware, software, and/or firmware configured to affect the herein-referenced method aspects depending upon the design choices of the system designer. In addition to the foregoing, various other method and/or system aspects are set forth and described in the teachings such as text (e.g., claims and/or detailed description) and/or drawings of the present disclosure.

Further, it is understood that any one or more of the following-described forms, expressions of forms, examples, can be combined with any one or more of the other following-described forms, expressions of forms, and examples.

The foregoing summary is illustrative only and is not intended to be in any way limiting. In addition to the illustrative aspects, embodiments, and features described above, further aspects, embodiments, and features will become apparent by reference to the drawings and the following detailed description.

FIGURES

The novel features of the described forms are set forth with particularity in the appended claims. The described forms, however, both as to organization and methods of operation, may be best understood by reference to the following description, taken in conjunction with the accompanying drawings in which:

FIG. 1 is a perspective view of a clamp arm portion of an end-effector for use with a combined ultrasonic/RF device, according to at least one aspect of the present disclosure.

FIG. 2 is an exploded view of the clamp arm shown in FIG. 1 , according to at least one aspect of the present disclosure.

FIGS. 3 and 4 are perspective views of the frame, according to at least one aspect of the present disclosure.

FIG. 5 is a perspective view of the electrode, according to at least one aspect of the present disclosure.

FIG. 6 is a perspective view of the clamp arm pad, according to at least one aspect of the present disclosure.

FIG. 7 is a perspective top view of the large gap pad, according to at least one aspect of the present disclosure.

FIG. 8 is a perspective top view of the small gap pad, according to at least one aspect of the present disclosure.

FIG. 9 is a perspective bottom view of the small gap pad shown in FIG. 8 .

FIGS. 10A-10B, there is illustrated an electrode having a proximal end fixedly attached to a proximal end of a clamp arm and having a distal end opposite to the fixed end that is free to move or deflect, where FIG. 10A illustrates a clamp arm and FIG. 10B illustrates a electrode, according to at least one aspect of the present disclosure.

FIGS. 11A-11D illustrate an electrode having a proximal end fixedly attached to a proximal end of a clamp arm and having a distal end opposite to the fixed end that is free to move or deflect, according to at least one aspect of the present disclosure, where:

FIG. 11A is an end-effector comprising a clamp arm, a peripheral electrode defining an inner aperture, and a connection pad isolated from a conductive portion of the peripheral electrode to attach the peripheral electrode to a proximal end of the clamp arm, according to at least one aspect of the present disclosure;

FIG. 11B is a top view of the peripheral electrode and a side partial side view of the end-effector, according to at least one aspect of the present disclosure;

FIG. 11C is a side view of an end-effector comprising a clamp arm and an ultrasonic blade and a top view of a peripheral electrode configured to attach to a proximal end of the clamp arm, according to at least one aspect of the present disclosure; and

FIG. 11D is a side view of an end-effector comprising a clamp arm and an ultrasonic blade and a top view of a peripheral electrode configured to attach to a proximal end of the clamp arm, according to at least one aspect of the present disclosure.

FIGS. 12A-12D illustrate a clamp arm comprising an electrode having a proximal end fixedly attached to a proximal end of the clamp arm and having a distal end opposite to the fixed end that is free to move or deflect, according to at least one aspect of the present disclosure, where:

FIG. 12A illustrates a clamp arm comprises a jaw, a clamp arm pad, and an electrode, according to at least one aspect of the present disclosure;

FIG. 12B is a section view of the clamp arm viewed from the perspective of the distal end of the clamp arm, according to at least one aspect of the present disclosure;

FIG. 12C is a section view of the clamp arm pad with a backing, according to at least one aspect of the present disclosure; and

FIG. 12D is a clamp arm comprising a clamp jaw, a clamp arm pad, and a deflectable cantilever electrode, according to at least one aspect of the present disclosure.

FIGS. 13A-13B illustrate a clamp arm comprising an electrode and a clamp arm pad, according to at least one aspect of the present disclosure, where:

FIG. 13A shows the electrode in an unloaded undeflected state; and

FIG. 13B shows the electrode in a loaded deflected state.

FIGS. 14A-14C illustrate an electrode configuration with an end-of-life indicator, which could be sensed by a generator, to prompt device replacement, according to various aspects of the resent disclosure, where:

FIG. 14A, there is illustrated an end-effector comprising a clamp arm and an ultrasonic blade, according to at least one aspect of the present disclosure; and

FIG. 14B shows the end-of-life indicator tail at the start of a procedure and FIG. 14C shows the end-of-life indicator tail at the end of the procedure; and

FIG. 14C shows the end-of-life indicator tail at the end of the procedure.

FIGS. 15A-15B illustrate an electrode configuration with an end-of-life indicator, which could be sensed by a generator, to prompt device replacement, according to various aspects of the resent disclosure, where:

FIG. 15A illustrates an end-effector comprising a clamp arm and an ultrasonic blade, according to at least one aspect of the present disclosure; and

FIG. 15B illustrates the end-effector of FIG. 15A after the clamp arm pad is worn close to failure.

FIGS. 16A-16B illustrate configurations wherein the electrode can move vertically along its entire length, according to various aspects of the present disclosure, where:

FIG. 16A shows a clamp arm portion of an end-effector, according to at least one aspect of the present disclosure; and

FIG. 16B shows the wear resistant clamp arm pad is mounted to an end of the lubricious clamp arm pad to help reduce wear of the lubricious clamp arm pad.

FIG. 17 illustrates a configuration wherein the electrode can move vertically along its entire length, according to various aspects of the present disclosure.

FIGS. 18A-18D illustrate configurations wherein the electrode can move vertically along its entire length, according to various aspects of the present disclosure, where:

FIG. 18A is a section view of an end-effector comprising a clamp arm, according to at least one aspect of the present disclosure;

FIG. 18B is a section view of the end-effector showing the location of the wear resistant dowel pins in the clamp arm;

FIG. 18C is a section view of a wear resistant dowel pin, according to at least one aspect of the present disclosure; and

FIG. 18D is a section view of a wear resistant dowel pin, according to at least one aspect of the present disclosure.

FIG. 19A illustrates a portion of an end-effector comprising a clamp arm comprising an electrode with a “center pivot” configuration, according to at least one aspect of the present disclosure.

FIG. 19B illustrates a portion of an end-effector comprising a clamp arm comprising an electrode with a “center pivot” configuration, according to at least one aspect of the present disclosure.

FIG. 20 illustrates an end-effector comprising a clamp arm and an ultrasonic blade, according to at least one aspect of the present disclosure.

FIG. 21 illustrates a spring element formed into an electrode, according to at least one aspect of the present disclosure

FIGS. 22A-22C illustrates a clamp arm comprising a wave spring element supporting an electrode, according to at least one aspect of the present disclosure, where:

FIG. 22A illustrates one aspect of the clamp arm where the wave spring element is formed integral with the resilient clamp arm pad to deflect the electrode in direction “d”;

FIG. 22B illustrates one aspect of a clamp arm where the wave spring element is positioned between the resilient clamp arm pad and the electrode to deflect the electrode in direction “d”; and

FIG. 22C illustrates one aspect of a clamp arm where the wave spring element also is formed integral with the resilient clamp arm pad to deflect the electrode in direction “d”.

FIGS. 23A-23B illustrate electrode attachment methods, according to various aspects of the present disclosure, where

FIG. 23A illustrates the electrode is disposed through protrusions in the clamp arm pad and attached to the clamp arm by a bracket; and

FIG. 23B illustrates the electrode is attached to the clamp arm pad by a cylindrical spring.

FIGS. 24A-24C illustrate electrode spring element configurations, according to various aspects of the present disclosure, where:

FIG. 24A illustrates an end-effector comprising a clamp arm and an ultrasonic blade, according to at lease one aspect of the present disclosure;

FIG. 24B illustrates a clamp arm comprising a diaphragm electrode, according to at least one aspect of the present disclosure; and

FIG. 24C illustrates a clamp arm comprising a one piece spring electrode, according to at least one aspect of the present disclosure.

FIG. 25 illustrates an electrode comprising a coined bump for use with integral wear pads (not shown), according to at least one aspect of the present disclosure.

FIG. 26 illustrates springs tested under heat and tissue fluid conditions, according to at least one aspect of the present disclosure.

FIG. 27 illustrates an extended length electrode to prevent binding of the electrode as it deflects up and down, the distance “d1” of the electrode may be increased, according to at least one aspect of the present disclosure.

FIGS. 28A-28D illustrate an end-effector configured with one or more than one resistor embedded (integrated) in a clamp arm pad to sense the height “h” of the clamp arm pad, according to at least one aspect of the present disclosure, where:

FIG. 28A illustrates a new clamp arm pad and does not show any wear and the resistors and the clamp arm pad are whole and indicate a full resistance value at full height h₁ with no tissue between the clamp arm and the ultrasonic blade, according to at least one aspect of the present disclosure;

FIG. 28B illustrates the end-effector with no tissue between the clamp arm and the ultrasonic blade and with the clamp arm pad and resistors worn to a height of h₂, which is less than h₁ due to heat generated by friction between the clamp arm and the ultrasonic blade and the resistors;

FIG. 28C illustrates the condition where the electrode is deflected to a height of h₃, which is less than h₁, due to thick tissue located between the clamp arm and the ultrasonic blade; and

FIG. 28D illustrates the condition where the electrode is deflected to a height of h₃, which is less than h₁, due to thick tissue located between the clamp arm and the ultrasonic blade.

FIG. 29 is a graphical illustration of one example of a resistance level of resistor in clamp arm pad versus pad height “h”, according to at least one aspect of the present disclosure.

FIGS. 30A-30B illustrate the resistance level (R1-R5) as a function of the height “h” of the resistor and analogously the height “h” of the clamp arm pad because the resistor is embedded in the clamp arm pad and both elements will wear at the same rate, according to at least one aspect of the present disclosure, where:

FIG. 30A shows the end-effector with a new clamp arm pad and resistor mounted in the clamp arm; and

FIG. 30B illustrates the state of the end-effector when the clamp arm pad is slightly worn to indicate a resistance level.

FIG. 31 is a graphical illustration of clamp arm pad height “h”, as measured by an integrated resistor, shown along the vertical axis, as a function of time “t”, shown along the horizontal axis, according to at least one aspect of the present disclosure.

FIG. 32 illustrates one configuration wherein the electrode can pivot near the mid-point of the electrode, according to at least one aspect of the present disclosure, where FIG. 32 is an exploded view of a clamp arm comprising a center pivoting electrode, according to at least one aspect of the present disclosure.

FIGS. 33A-33B illustrate configurations wherein the electrode can pivot near the mid-point of the electrode, according to at least one aspect of the present disclosure, where:

FIG. 33A illustrates new pads such that at full clamp the center pivoting electrode is a predetermined angle (e.g., parallel) relative to the clamp arm jaw), according to at least one aspect of the present disclosure; and

FIG. 33B shows the change in angle θ between the center pivoting electrode relative to the clamp arm jaw 1526 in order to maintain a consistent gap between the ultrasonic blade, according to at least one aspect of the present disclosure.

FIG. 34 is a perspective section view of a clamp arm comprising a longitudinally aligned slot from a proximal end through which an electrode plate may be advanced without the clamp arm pad material, according to at least one aspect of the present disclosure.

FIG. 35A is a section view of the clamp arm shown in FIG. 34 prior to assembly, according to at least one aspect of the present disclosure.

FIG. 35B shows the clamp arm pad/electrode plate assembly slid proximally 1556 into the longitudinally aligned slot defined by the clamp jaw, according to at least one aspect of the present disclosure.

FIG. 35C shows the tab at the proximal end of the clamp arm pad locks into the proximal recess defined by the proximal end of the clamp jaw interlocking the clamp arm pad/electrode plate assembly 1560 with the clamp jaw, according to at least one aspect of the present disclosure.

FIG. 36 illustrates one aspect of a continuous spring support disposed under the electrode rather than discrete spring attachment at one end, according to at least one aspect of the present disclosure.

FIG. 37 is a perspective view of an end-effector comprising a laterally deflectable electrode, forming one pole of the electrosurgical circuit, and an ultrasonic blade, forming the other pole of the electrosurgical circuit, according to at least one aspect of the present disclosure.

FIG. 38 shows the laterally deflectable electrode in an undeflected state (shown in solid line) and in a deflected state (shown in broken line), according to at least one aspect of the present disclosure.

FIG. 39 is a section view of an end-effector comprising an electrode as a structural clamping member, forming one pole of the electrosurgical circuit, and an ultrasonic blade, forming the other pole of the electrosurgical circuit, according to at least one aspect of the present disclosure.

FIG. 40 is a section view of an end-effector comprising an electrode as a structural clamping member, forming one pole of the electrosurgical circuit, and an ultrasonic blade, forming the other pole of the electrosurgical circuit, according to at least one aspect of the present disclosure.

FIG. 41 is a section of an end-effector comprising an electrode as a structural clamping member, forming one pole of the electrosurgical circuit, and an ultrasonic blade, forming the other pole of the electrosurgical circuit, according to at least one aspect of the present disclosure.

FIG. 42 shows the electrode in its laterally deflected state (shown in broken line), according to at least one aspect of the present disclosure.

FIG. 43 illustrates a clamp arm comprising a laterally deflectable electrode, forming one pole of the electrosurgical circuit, according to at least one aspect of the present disclosure.

FIG. 44 illustrates a clamp arm comprising a laterally deflectable electrode, forming one pole of the electrosurgical circuit, according to at least one aspect of the present disclosure.

FIGS. 45-46 illustrate an end-effector comprising a laterally deflectable electrode, forming one pole of the electrosurgical circuit, and an ultrasonic blade, forming the other pole of the electrosurgical circuit, according to at least one aspect of the present disclosure, where:

FIG. 45 with a distance d between the center of the electrode to the most lateral extension of the electrode; and

FIG. 46 shows a laterally deflected state of the electrode with a distance d′ between the center of the electrode to the most lateral extension of the electrode.

FIG. 47 illustrates an end-effector comprising a laterally deflectable electrode, forming one pole of the electrosurgical circuit, and an ultrasonic blade, forming the other pole of the electrosurgical circuit, according to at least one aspect of the present disclosure.

FIG. 48 illustrates an end-effector comprising a laterally deflectable electrode, forming one pole of the electrosurgical circuit, and an ultrasonic blade, forming the other pole of the electrosurgical circuit, according to at least one aspect of the present disclosure.

FIG. 49 illustrates the lateral deflection of the laterally deflectable electrode in broken line in the direction of the arrows.

FIG. 50 is a magnified view of the laterally deflectable electrode where the lateral deflection is shown in broken line.

FIG. 51 illustrates an end-effector comprising a pair of metal clamp arms coated with a compliant or deformable dielectric material and a wire electrode, according to at least one aspect of the present disclosure.

FIG. 52 illustrates an end-effector comprising a pair of metal clamp arms coated with a compliant or deformable dielectric material and a wire electrode, according to at least one aspect of the present disclosure.

FIG. 53 illustrates an end-effector comprising a pair of metal clamp arms coated with a compliant or deformable dielectric material and a wire electrode, according to at least one aspect of the present disclosure.

FIG. 54 illustrates an end-effector comprising a pair of metal clamp arms coated with a compliant or deformable dielectric material and a wire electrode, according to at least one aspect of the present disclosure.

FIG. 55 illustrates a compliant or deformable dielectric material can be the same material (e.g., silicone) or can be a harder or softer material, according to at least one aspect of the present disclosure.

FIG. 56 illustrates the metal clamp arms implemented as bipolar electrodes by adding outer electrodes, according to at least one aspect of the present disclosure.

FIG. 57 illustrates bare metal or coated/covered metal clamp arms, according to at least one aspect of the present disclosure.

FIG. 58 illustrates bare metal or coated/covered metal clamp arms, according to at least one aspect of the present disclosure.

FIGS. 59-61 illustrate an effector comprising a shortened clamp arm for deflectable/cantilever electrode applications, according to various aspects of the present disclosure, where:

FIG. 59 is a side view of an end-effector comprising a shortened clamp arm, an ultrasonic blade, an electrode, and a clamp arm pad, according to at least one aspect of the present disclosure;

FIG. 60 is a top view of the end-effector, according to at least one aspect of the present disclosure; and

FIG. 61 illustrates a clamp arm comprising a clamp jaw, an electrode, and a clamp arm pad, according to at least one aspect of the present disclosure.

FIG. 62 illustrates an end-effector clamp arm comprising a clamp jaw, an electrode, and a clamp arm pad, according to at least one aspect of the present disclosure.

FIG. 63 illustrates an end-effector clamp arm comprising a clamp jaw, an electrode, and a clamp arm pad, according to at least one aspect of the present disclosure.

FIG. 64 illustrates an end-effector clamp arm comprising a clamp jaw, an electrode, and a clamp arm pad, according to at least one aspect of the present disclosure.

FIG. 65 illustrates bottom retainer tooth that is worn away such that the electrode can move toward the clamp jaw due to the pre-formed curve, according to at least one aspect of the present disclosure.

FIG. 66 illustrates an end-effector clamp arm comprising a clamp jaw, an electrode, and a clamp arm pad, according to at least one aspect of the present disclosure.

FIG. 67 illustrates a retainer wall with a tapered profile worn away such that there is sufficient melting/flowing away from the retainer wall with the tapered profile region to allow the electrode to move toward the clamp jaw due to the pre-formed curve, according to at least one aspect of the present disclosure.

FIGS. 68-70 illustrate an end-effector comprising a clamp arm, an ultrasonic blade, a lattice cushion, a flexible electrode disposed above the lattice cushion, and a plurality of hard spacers to set a gap between the flexible electrode and the ultrasonic blade, according to at least one aspect of the present disclosure, where:

FIG. 68 illustrates the clamp arm open and tissue of non-uniform thickness (T_(1a), T_(2a), T_(3a)) is disposed over the flexible electrode;

FIG. 69 the clamp arm is closed to compress the tissue; and

FIG. 70 is an exploded view of the end-effector shown in FIGS. 68-69 .

FIG. 71 is a section view of a conductive polymer clamp arm pad, according to at least one aspect of the present disclosure.

FIG. 72 is a perspective view of a clamp arm pad configured to replace a conventional electrode, according to at least one aspect of the present disclosure.

FIG. 73 illustrates a clamp arm comprising the clamp arm pad described in FIG. 72 , according to at least one aspect of the present disclosure.

FIG. 74 illustrates clamp arm pads configured as described in FIGS. 72-73 , according to at least one aspect of the present disclosure.

FIG. 75 is a section view of a clamp arm comprising a composite clamp arm pad in contact with tissue, according to at least one aspect of the present disclosure.

FIG. 76 illustrates a clamp arm comprising a clamp jaw to support a carrier or stamping attached to the clamp jaw and a clamp arm pad, according to at least one aspect of the present disclosure.

FIG. 77 is a section view taken at section 77-77 in FIG. 76 .

FIG. 78 is a section view taken at section 78-78 in FIG. 76 .

FIG. 79 is a section view of an alternative implementation of a clamp arm comprising a clamp jaw, an electrically conductive pad, and an electrically non-conductive pad, according to at least one aspect of the present disclosure.

FIG. 80 is a section view of an alternative implementation of a clamp arm comprising a clamp jaw, a carrier or stamping welded to the clamp jaw, an electrically conductive pad, and an electrically non-conductive pad, according to at least one aspect of the present disclosure.

FIG. 81 illustrates insert molded electrodes, according to at least one aspect of the present disclosure.

FIG. 82 illustrates an end-effector comprising an ultrasonic blade, a clamp arm, and a clamp arm pad comprising an electrically conductive film, according to at least one aspect of the present disclosure.

FIG. 83 illustrates the clamp arm shown in FIG. 82 .

FIG. 84 is a section view of the clamp arm taken along section 84-84 in FIG. 83 .

FIG. 85 illustrates a clamp arm comprising a partially electrically conductive clamp arm pad, according to at least one aspect of the resent disclosure.

FIG. 86 illustrates a surgical device comprising a mode selection button switch on the device, according to at least one aspect of the present disclosure.

FIGS. 87A-87C illustrate three options for selecting the various operating modes of the surgical device, according to at least one aspect of the present disclosure, where:

FIG. 87A shows a first mode selection option where the button switch can be pressed forward or backward to cycle the surgical instrument through the various modes;

FIG. 87B shows a second mode selection option where the button switch is pressed up or down to cycle the surgical instrument through the various modes; and

FIG. 87C shows a third mode selection option where the button switch is pressed forward, backward, up, or down to cycle the surgical instrument through the various modes.

FIG. 88 illustrates a surgical device comprising a mode selection button switch on the back of the device, according to at least one aspect of the present disclosure.

FIG. 89A shows a first mode selection option where as the mode button switch is pressed to toggled through various modes, colored light indicates the selected mode on the user interface.

FIG. 89B shows a second mode selection option where as the mode button switch is pressed to toggle through various modes a screen indicates the selected mode (e.g., LCD, e-ink).

FIG. 89C shows a third mode selection option where as the mode button switch is pressed to toggle through various modes, labelled lights indicate the selected mode.

FIG. 89D shows a fourth mode selection option where as a labeled button switch is pressed to select a mode, when a labeled button switch is selected, it is illuminated to indicate mode selected.

FIG. 90 illustrates a surgical device comprising a trigger activation mechanism, according to at least one aspect of the present disclosure.

FIG. 91 illustrates an alternative clamp arm comprising a metal clamp jaw, an electrode, a plurality of clamp arm pads, and gap pads, according to at least one aspect of the present disclosure.

FIG. 92 is a surgical system comprising a surgical hub paired with a visualization system, a robotic system, and an intelligent instrument, in accordance with at least one aspect of the present disclosure.

FIG. 93 illustrates an example of a generator, in accordance with at least one aspect of the present disclosure.

FIG. 94 is a diagram of various modules and other components that are combinable to customize modular energy systems, in accordance with at least one aspect of the present disclosure.

FIG. 95A is a first illustrative modular energy system configuration including a header module and a display screen that renders a graphical user interface (GUI) for relaying information regarding modules connected to the header module, in accordance with at least one aspect of the present disclosure.

FIG. 95B is the modular energy system shown in FIG. 95A mounted to a cart, in accordance with at least one aspect of the present disclosure.

FIG. 96 depicts a perspective view of an exemplary surgical system having a generator and a surgical instrument operable to treat tissue with ultrasonic energy and bipolar RF energy, in accordance with at least one aspect of the present disclosure.

FIG. 97 depicts a top perspective view of an end effector of the surgical instrument of FIG. 96 , having a clamp arm that provides a first electrode and an ultrasonic blade that provides a second electrode, in accordance with at least one aspect of the present disclosure.

FIG. 98 depicts a bottom perspective view of the end effector of FIG. 97 , in accordance with at least one aspect of the present disclosure.

FIG. 99 depicts a partially exploded perspective view of the surgical instrument of FIG. 96 , in accordance with at least one aspect of the present disclosure.

FIG. 100 depicts an enlarged exploded perspective view of a distal portion of the shaft assembly and the end effector of the surgical instrument of FIG. 96 , in accordance with at least one aspect of the present disclosure.

DESCRIPTION

Applicant of the present application owns the following U.S. Provisional Patent Applications, filed on Dec. 30, 2019, the disclosure of each of which is herein incorporated by reference in its respective entirety:

-   -   U.S. Provisional Patent Application Ser. No. 62/955,294,         entitled USER INTERFACE FOR SURGICAL INSTRUMENT WITH COMBINATION         ENERGY MODALITY END-EFFECTOR;     -   U.S. Provisional Patent Application Ser. No. 62/955,299,         entitled ELECTROSURGICAL INSTRUMENTS FOR COMBINATION ENERGY         DELIVERY; and     -   U.S. Provisional Patent Application Ser. No. 62/955,306,         entitled SURGICAL INSTRUMENTS.

Applicant of the present application owns the following U.S. Patent Applications that were filed on May 29, 2020, and which are each herein incorporated by reference in their respective entireties:

-   -   U.S. patent application Ser. No. 16/887,499, entitled USER         INTERFACE FOR SURGICAL INSTRUMENT WITH COMBINATION ENERGY         MODALITY END-EFFECTOR, now U.S. Patent Application Publication         No. 2021/0196345;     -   U.S. patent application Ser. No. 16/887,493, entitled METHOD OF         OPERATING A COMBINATION ULTRASONIC/BIPOLAR RF SURGICAL DEVICE         WITH A COMBINATION ENERGY MODALITY END-EFFECTOR, now U.S. Patent         Application Publication No. 2021/0196334;     -   U.S. patent application Ser. No. 16/887,515 entitled NON-BIASED         DEFLECTABLE ELECTRODE TO MINIMIZE CONTACT BETWEEN ULTRASONIC         BLADE AND ELECTRODE, now U.S. Patent Application Publication No.         2021/0196306;     -   U.S. patent application Ser. No. 16/887,519, entitled         DEFLECTABLE ELECTRODE WITH HIGHER DISTAL BIAS RELATIVE TO         PROXIMAL BIAS, now U.S. Patent Application Publication No.         2021/0196307;     -   U.S. patent application Ser. No. 16/887,532, entitled         DEFLECTABLE ELECTRODE WITH VARIABLE COMPRESSION BIAS ALONG THE         LENGTH OF THE DEFLECTABLE ELECTRODE, now U.S. Patent Application         Publication No. 2021/0196335;     -   U.S. patent application Ser. No. 16/887,554, entitled ASYMMETRIC         SEGMENTED ULTRASONIC SUPPORT PAD FOR COOPERATIVE ENGAGEMENT WITH         A MOVABLE RF ELECTRODE, now U.S. Patent Application Publication         No. 2021/0196336;     -   U.S. patent application Ser. No. 16/887,561, entitled VARIATION         IN ELECTRODE PARAMETERS AND DEFLECTABLE ELECTRODE TO MODIFY         ENERGY DENSITY AND TISSUE INTERACTION, now U.S. Patent         Application Publication No. 2021/0196346;     -   U.S. patent application Ser. No. 16/887,568 entitled TECHNIQUES         FOR DETECTING ULTRASONIC BLADE TO ELECTRODE CONTACT AND REDUCING         POWER TO ULTRASONIC BLADE, now U.S. Patent Application         Publication No. 2021/0196305;     -   U.S. patent application Ser. No. 16/887,576, entitled CLAMP ARM         JAW TO MINIMIZE TISSUE STICKING AND IMPROVE TISSUE CONTROL, now         U.S. Patent Application Publication No. 2021/0196367; and     -   U.S. patent application Ser. No. 16/887,579, entitled PARTIALLY         CONDUCTIVE CLAMP ARM PAD TO ENABLE ELECTRODE WEAR THROUGH AND         MINIMIZE SHORT CIRCUITING, now U.S. Patent Application         Publication No. 2021/0196352.

Applicant of the present application owns the following U.S. patent applications that were filed on May 28, 2020, and which are each herein incorporated by reference in their respective entireties:

-   -   U.S. patent application Ser. No. 16/885,813, entitled METHOD FOR         AN ELECTROSURGICAL PROCEDURE;     -   U.S. patent application Ser. No. 16/885,820, entitled         ARTICULATABLE SURGICAL INSTRUMENT;     -   U.S. patent application Ser. No. 16/885,823, entitled SURGICAL         INSTRUMENT WITH JAW ALIGNMENT FEATURES;     -   U.S. patent application Ser. No. 16/885,826, entitled SURGICAL         INSTRUMENT WITH ROTATABLE AND ARTICULATABLE SURGICAL END         EFFECTOR;     -   U.S. patent application Ser. No. 16/885,838, entitled         ELECTROSURGICAL INSTRUMENT WITH ASYNCHRONOUS ENERGIZING         ELECTRODES;     -   U.S. patent application Ser. No. 16/885,851, entitled         ELECTROSURGICAL INSTRUMENT WITH ELECTRODES BIASING SUPPORT;     -   U.S. patent application Ser. No. 16/885,860, entitled         ELECTROSURGICAL INSTRUMENT WITH FLEXIBLE WIRING ASSEMBLIES;     -   U.S. patent application Ser. No. 16/885,866, entitled         ELECTROSURGICAL INSTRUMENT WITH VARIABLE CONTROL MECHANISMS;     -   U.S. patent application Ser. No. 16/885,870, entitled         ELECTROSURGICAL SYSTEMS WITH INTEGRATED AND EXTERNAL POWER         SOURCES;     -   U.S. patent application Ser. No. 16/885,873, entitled         ELECTROSURGICAL INSTRUMENTS WITH ELECTRODES HAVING ENERGY         FOCUSING FEATURES;     -   U.S. patent application Ser. No. 16/885,879, entitled         ELECTROSURGICAL INSTRUMENTS WITH ELECTRODES HAVING VARIABLE         ENERGY DENSITIES;     -   U.S. patent application Ser. No. 16/885,881, entitled         ELECTROSURGICAL INSTRUMENT WITH MONOPOLAR AND BIPOLAR ENERGY         CAPABILITIES;     -   U.S. patent application Ser. No. 16/885,888, entitled         ELECTROSURGICAL END EFFECTORS WITH THERMALLY INSULATIVE AND         THERMALLY CONDUCTIVE PORTIONS;     -   U.S. patent application Ser. No. 16/885,893, entitled         ELECTROSURGICAL INSTRUMENT WITH ELECTRODES OPERABLE IN BIPOLAR         AND MONOPOLAR MODES;     -   U.S. patent application Ser. No. 16/885,900, entitled         ELECTROSURGICAL INSTRUMENT FOR DELIVERING BLENDED ENERGY         MODALITIES TO TISSUE;     -   U.S. patent application Ser. No. 16/885,917, entitled CONTROL         PROGRAM ADAPTATION BASED ON DEVICE STATUS AND USER INPUT;     -   U.S. patent application Ser. No. 16/885,923, entitled CONTROL         PROGRAM FOR MODULAR COMBINATION ENERGY DEVICE; and     -   U.S. patent application Ser. No. 16/885,931, entitled SURGICAL         SYSTEM COMMUNICATION PATHWAYS.

Before explaining various forms of surgical instruments in detail, it should be noted that the illustrative forms are not limited in application or use to the details of construction and arrangement of parts illustrated in the accompanying drawings and description. The illustrative forms may be implemented or incorporated in other forms, variations and modifications, and may be practiced or carried out in various ways. Further, unless otherwise indicated, the terms and expressions utilized herein have been chosen for the purpose of describing the illustrative forms for the convenience of the reader and are not for the purpose of limitation thereof.

Further, it is understood that any one or more of the following-described forms, expressions of forms, examples, can be combined with any one or more of the other following-described forms, expressions of forms, and examples.

Various forms are directed to improved ultrasonic and/or electrosurgical (RF) instruments configured for effecting tissue treating, dissecting, cutting, and/or coagulation during surgical procedures. In one form, a combined ultrasonic and electrosurgical instrument may be configured for use in open surgical procedures, but has applications in other types of surgery, such as minimally invasive laparoscopic, orthoscopic, or thoracoscopic procedures, for example, non-invasive endoscopic procedures, either in hand held or and robotic-assisted procedures. Versatility is achieved by selective application of multiple energy modalities simultaneously, independently, sequentially, or combinations thereof. For example, versatility may be achieved by selective use of ultrasonic and electrosurgical energy (e.g., monopolar or bipolar RF energy) either simultaneously, independently, sequentially, or combinations thereof.

In one aspect, the present disclosure provides an ultrasonic surgical clamp apparatus comprising an ultrasonic blade and a deflectable RF electrode such that the ultrasonic blade and deflectable RF electrode cooperate to effect sealing, cutting, and clamping of tissue by cooperation of a clamping mechanism of the apparatus comprising the RF electrode with an associated ultrasonic blade. The clamping mechanism includes a pivotal clamp arm which cooperates with the ultrasonic blade for gripping tissue therebetween. The clamp arm is preferably provided with a clamp tissue pad (also known as “clamp arm pad”) having a plurality of axially spaced gripping teeth, segments, elements, or individual units which cooperate with the ultrasonic blade of the end-effector to achieve the desired sealing and cutting effects on tissue, while facilitating grasping and gripping of tissue during surgical procedures.

In one aspect, the end-effectors described herein comprise an electrode. In other aspects, the end-effectors described herein comprise alternatives to the electrode to provide a compliant coupling of RF energy to tissue, accommodate pad wear/thinning, minimize generation of excess heat (low coefficient of friction, pressure), minimize generation of sparks, minimize interruptions due to electrical shorting, or combinations thereof. The electrode is fixed to the clamp jaw at the proximal end and is free to deflect at the distal end. Accordingly, throughout this disclosure the electrode may be referred to as a cantilever beam electrode or as a deflectable electrode.

In other aspects, the end-effectors described herein comprise a clamp arm mechanism configured to apply high pressure between a pad and an ultrasonic blade to grasp and seal tissue, maximize probability that the clamp arm electrode contacts tissue in limiting or difficult scenarios, such as, for example, thin tissue, tissue under lateral tension, tissue tenting/vertical tension especially tenting tissue away from clamp arm.

In other aspects, the end-effectors described herein are configured to balance match of surface area/current densities between electrodes, balance and minimize thermal conduction from tissue interface, such as, for example, impacts lesion formation and symmetry, cycle time, residual thermal energy.

In other aspects, the end-effectors described herein are configured to minimize sticking, tissue adherence (minimize anchor points) and may comprise small polyimide pads.

In various aspects, the present disclosure provides a combination ultrasonic/bipolar RF energy surgical device. The combination ultrasonic/bipolar RF energy surgical device comprises an end-effector. The end-effector comprises a clamp arm and an ultrasonic blade. The clamp arm comprises a movable clamp jaw, a compliant polymeric pad, and at least one bipolar RF electrode. The at least one electrode is coupled to a positive pole of an RF generator and the ultrasonic blade is coupled to the negative pole of the RF generator. The ultrasonic blade is acoustically coupled to an ultrasonic transducer stack that is driven by an ultrasonic generator. In various aspects, the end-effector comprises electrode biasing mechanisms.

In one general aspect, the present disclosure is directed to a method for using a surgical device comprising a combination of ultrasonic and advanced bipolar RF energy with a movable RF electrode on at least one jaw of an end-effector. The movable RF electrode having a variable biasing force from a proximal end to a distal end of the movable RF electrode. The movable RF electrode being segmented into discrete portions than can be put in electrical communication or isolated from each other. The movable RF electrode being made of a conductive or partially conductive material. It will be appreciated that any of the end effectors described in this disclosure may be configured with an electrode biasing mechanism.

In one aspect, the present disclosure provides a limiting electrode biasing mechanism to prevent ultrasonic blade to electrode damage. Generally, in various aspects, the present disclosure provides an end-effector for use with a ultrasonic/RF combination device, where the end-effector comprises an electrode. In one aspect, the combination ultrasonic/bipolar RF energy surgical device comprises an electrode biasing mechanism. In one aspect, the limiting electrode biasing mechanism is configured to prevent or minimize ultrasonic blade to electrode damage. The electrode is fixed to the clamp jaw at the proximal end and is free to deflect at the distal end. Accordingly, throughout this disclosure the electrode may be referred to as a cantilever beam electrode or as a deflectable electrode.

In various aspects, the present disclosure provides an electrode cantilever beam fixated at only one end comprising a biasing threshold mechanism. In one aspect, the deflectable cantilever electrode is configured for combination ultrasonic/bipolar RF energy surgical devices.

In one aspect, the combination ultrasonic/RF energy surgical device comprises an ultrasonic blade, a clamp arm, and at least one electrode which crosses over the ultrasonic blade. In one aspect, the electrode is configured to be deflectable with respect to the clamp arm and includes features to change the mechanical properties of the tissue under compression between the electrode and the ultrasonic blade. In another aspect, the electrode includes a feature to prevent inadvertent contact between the electrode and the ultrasonic blade to prevent or minimize ultrasonic blade to electrode damage.

In various aspects, the electrode comprises a metallic spring element attached at a proximal end of the clamp jaw of the end-effector. The metallic spring element defines openings for receives therethrough one or more clamp arm pads (also known as “tissue pads” or “clamp tissue pads”) and comprises integrated minimum gap elements. This configuration of the electrode provides a method of preventing tissue from accumulating around the biasing mechanism that can impact the performance of the electrode. This configuration also minimizes the binding between the wear pads and the biasing spring, increases the strength of the electrode to clamp arm connection, minimizes inadvertent release of the clamp arm pads by attaching the polyimide pads to the electrode, and balance matches the surface area/current densities between electrodes. The electrode is fixed to the clamp jaw at the proximal end and is free to deflect at the distal end. Accordingly, throughout this disclosure the electrode is deflectable and may be referred to as a cantilever beam electrode or deflectable electrode.

FIGS. 1-9 illustrate one aspect of an end-effector comprising a deflectable/cantilever electrode configured for use with a combination ultrasonic/bipolar RF energy device, according to at least one aspect of the present disclosure. FIG. 1 is a perspective view of a clamp arm 1000 portion of an end-effector for use with a combined ultrasonic/RF device, according to at least one aspect of the present disclosure. For conciseness and clarity of disclosure, the ultrasonic blade, which functions as the other clamp arm of the end-effector is not shown. The end-effector is configured such that the ultrasonic blade is one pole of the bipolar RF circuit and the clamp arm 1000 is the opposite pole. A consistent RF electrode gap is maintained between the clamp arm 1000 and the ultrasonic blade to prevent the ultrasonic blade from contacting the electrode resulting in blade breakage or a short circuit. Tissue under treatment is clamped and compressed between the clamp arm 1000 and the ultrasonic blade.

The clamp arm 1000 includes a frame 1002, an electrode 1004, at least one small electrically nonconductive gap pad 1006, at least one large electrically nonconductive gap pad 1008, at least one electrically nonconductive clamp arm pad 1010. In one aspect, the small and large gap pads 1006, 1008 are configured to set a gap between the electrode 1004 and the ultrasonic blade. The clamp arm pad 1010 is configured to grasp tissue between the clamp arm 1000 and the ultrasonic blade to assist with sealing and cutting of the tissue. In other aspects, the small and large nonconductive gap pads may be swapped. In other aspects, the nonconductive gap pads are simply sized differently regardless of the relative size difference between the nonconductive gap pads.

Pivotal movement of the clamp arm 1000 with respect to the end-effector is effected by the provision of at least one, and preferably a pair of, lever portions 1012 of the clamp arm 1000 frame 1002 at a proximal end 1014 thereof. The lever portions 1012 are positioned on respective opposite sides of an ultrasonic waveguide and end-effector, and are in operative engagement with a drive portion of a reciprocable actuating member. Reciprocable movement of the actuating member, relative to an outer tubular sheath and the ultrasonic waveguide, thereby effects pivotal movement of the clamp arm 1000 relative to the end-effector about pivot points 1016. The lever portions 1012 can be respectively positioned in a pair of openings defined by the drive portion, or otherwise suitably mechanically coupled therewith, whereby reciprocable movement of the actuating member acts through the drive portion and lever portions 1012 to pivot the clamp arm 1000.

FIG. 2 is an exploded view of the clamp arm 1000 shown in FIG. 1 , according to at least one aspect of the present disclosure. In various aspects, the electrode 1004 is made of a metallic spring material attached at a proximal end 1014 of the frame 1002 of the clamp arm 1000 such that the electrode 1004 can deflect. The metallic spring electrode 1004 defines openings 1018 for receiving therethrough elements of the clamp arm pad 1010 and defines additional openings 1020, 1021 for receiving the gap pads 1006, 1008 to set a minimum gap between the electrode 1004 and the ultrasonic blade. At least one of the gap pads 1006 is disposed on a distal end 1022 of the electrode 1004. The gap pads 1006, 1008 are thus integrated with the electrode 1004. In this configuration, the electrode 1004 prevents tissue from accumulating around the biasing mechanism, e.g., cantilevered spring, that can impact the performance of the electrode 1004. This configuration also minimizes the binding between the wearable clamp arm pads 1010 and the biasing spring electrode 1004, increases the strength of the electrode 1004 to the clamp arm connection, minimizes inadvertent release of the clamp arm pads 1018 by attaching the gap pads 1006, 1008 to the electrode 1004, and balance matches the surface area/current densities between electrodes. The electrode 1004 is attached to the frame 1002 by two protrusions 1024. The electrode protrusions 1024 are attached to the proximal end 1014 of the frame 1002 as shown in FIGS. 3 and 4 .

FIGS. 3 and 4 are perspective views of the frame 1002, according to at least one aspect of the present disclosure. These views illustrate the connection surfaces 1026 on the proximal end 1014 of the fame 1002 for attaching the proximal end of the electrode 1004 to the frame 1002. In one aspect, the electrode protrusions 1024 are welded to the connection surfaces 1026 of the frame 1002 such that the electrode 1004 behaves in a deflectable manner.

FIG. 5 is a perspective view of the electrode 1004, according to at least one aspect of the present disclosure. This view illustrates the bias in the electrode 1004 made of spring material as indicated by the curvature of the electrode 1004 along a longitudinal length. The openings 1018, 1020, 1021 for receiving the gap pads 1006, 1008 and the clamp arm pads 1010. In one aspect, the electrode 1004 has a thickness “d” of 0.010″ and may be selected within a range of thicknesses of 0.005″ to 0.015″, for example. With reference also to FIGS. 8 and 9 , the openings 1020 are sized and configured to receive a protrusion 1036 defined on a bottom portion of the gap pads 1006.

FIG. 6 is a perspective view of the clamp arm pad 1010, according to at least one aspect of the present disclosure. The clamp arm pad 1010 comprises a plurality of clamp arm elements 1032 protruding from a backbone 1030. Throughout this disclosure, the clamp arm elements 1032 also are referred to as “teeth.” In one aspect, the clamp arm pad 1010 defines apertures 1028 in a position where the gap pads 1006 are located on the electrode 1004. With reference also to FIGS. 8 and 9 , the apertures 1028 defined by the clamp arm pad 1010 are sized and configured to receive the protrusion 1036 defined on a bottom portion of the gap pads 1006. In one aspect, the clamp arm pad 1010 material is softer than the gap pad 1006, 1008 material. In one aspect, the clamp arm pad 1010 is made of a non-stick lubricious material such as polytetrafluoroethylene (PTFE) or similar synthetic fluoropolymers of tetrafluoroethylene. PTFE is a hydrophobic, non-wetting, high density and resistant to high temperatures, and versatile material and non-stick properties. In contrast, the gap pads 1006, 1008 are made of a polyimide material, and in one aspect, is made of a durable high-performance polyimide-based plastic known under the tradename VESPEL and manufactured by DuPont or other suitable polyimide, polyimide polymer alloy, or PET (Polyethylene Terephthalate), PEEK (Polyether Ether Ketone), PEKK (Poly Ether Ketone Ketone) polymer alloy, for example. Unless otherwise noted hereinbelow, the clamp arm pads and gap pads described hereinbelow are made of the materials described in this paragraph.

FIG. 7 is a perspective top view of the large gap pad 1008, according to at least one aspect of the present disclosure. The large gap pad 1008 comprises a protrusion 1034 sized and configured to fit within the opening 1021 at the proximal end 1014 of the electrode 1004. FIG. 8 is a perspective top view of the small gap pad 1006, according to at least one aspect of the present disclosure. FIG. 9 is a perspective bottom view of the small gap pad 1006 shown in FIG. 8 . As shown in FIGS. 8 and 9 , the small gap pads 1006 include a protrusion 1036 at the bottom portion sized and configured to be received within the openings 1020 defined by the electrode 1004 and the apertures 1028 defined by the clamp arm pad 1010. The small and large gap pads 1006, 1008 are made of a polyimide material, and in one aspect, is made of a durable high-performance polyimide-based plastic known under the tradename VESPEL and manufactured by DuPont. The durability of the polyimide material ensures that the electrode gap remains relatively constant under normal wear and tear.

In one aspect, the present disclosure also provides additional end-effector configurations for combination ultrasonic and bipolar RF energy devices. This portion of the disclosure provides end-effector configurations for use in combination ultrasonic and bipolar RF energy devices. In these configurations, the end-effector maintains a consistent gap between the RF electrode gap and the ultrasonic blade, which functions as one pole of the bipolar RF circuit, and the clamp arm, which functions as the opposite pole of the bipolar RF circuit. In conventional end-effector configurations, the electrode gap is set by a soft PTFE clamp arm pad which may be subject to wear during surgery. When the clamp arm pad wears through, the ultrasonic blade can contact the electrode resulting in blade breakage or an electrical short circuit, both of which are undesirable.

To overcome these and other limitations, various aspects of the present disclosure incorporate a deflectable RF electrode in combination with a clamp arm pad comprising a non-stick lubricious compliant (e.g., PTFE) pad fixed to the clamp arm. The RF electrode contains wear-resistant, electrically nonconductive pads which contact the blade to set the blade-to-electrode gap. The compliant clamp arm pad extends through openings defined by the electrode and reacts to the clamping force from the ultrasonic blade. As the compliant clamp arm pad wears, the electrode deflects to maintain a constant gap between the blade and the electrode. Such configuration provides a consistent gap between the electrode and the ultrasonic blade throughout the life of the device, prevents shorting and ultrasonic blade breakage, which can occur when the ultrasonic blade touches the electrode, and enables the electrode material to be positioned directly on the side that is opposite the ultrasonic blade to improve sealing performance. The electrode is fixed to the clamp jaw at the proximal end and is free to deflect at the distal end. Accordingly, throughout this disclosure the electrode may be referred to as a cantilever beam electrode or deflectable electrode.

In one aspect, the present disclosure also provides additional end-effector configurations for combination ultrasonic and bipolar RF energy devices. This portion of the disclosure provides end-effector configurations for use in combination ultrasonic and bipolar RF energy devices. In these configurations, the end-effector maintains a consistent gap between the RF electrode gap and the ultrasonic blade, which functions as one pole of the bipolar RF circuit, and the clamp arm, which functions as the opposite pole of the bipolar RF circuit. In conventional end-effector configurations, the electrode gap is set by a soft PTFE clamp arm pad which may be subject to wear during surgery. When the clamp arm pad wears through, the ultrasonic blade can contact the electrode resulting in blade breakage or an electrical short circuit, both of which are undesirable.

To overcome these and other limitations, various aspects of the present disclosure incorporate a deflectable RF electrode in combination with a clamp arm pad comprising a non-stick lubricious compliant (e.g., PTFE) pad fixed to the clamp arm. The RF electrode contains wear-resistant, electrically nonconductive pads which contact the blade to set the blade-to-electrode gap. The compliant clamp arm pad extends through openings defined by the electrode and reacts to the clamping force from the ultrasonic blade. As the compliant clamp arm pad wears, the electrode deflects to maintain a constant gap between the blade and the electrode. Such configuration provides a consistent gap between the electrode and the ultrasonic blade throughout the life of the device, prevents shorting and ultrasonic blade breakage, which can occur when the ultrasonic blade touches the electrode, and enables the electrode material to be positioned directly on the side that is opposite the ultrasonic blade to improve sealing performance. The electrode is fixed to the clamp jaw at the proximal end and is free to deflect at the distal end. Accordingly, throughout this disclosure the electrode may be referred to as a cantilever beam electrode or deflectable electrode.

FIGS. 10A-13B show configurations wherein a deflectable/cantilever electrode is fixed to a clamp arm at a proximal end and can move vertically distal of the attachment point, according to various aspects of the present disclosure. In each of the configurations shown and described in connection with FIGS. 10A-13B, the deflectable/cantilever electrode may be attached to the proximal end of the clamp arm by welding, brazing, soldering, or other suitable mounting technique. Furthermore, the clamp arm pad in each of the configurations illustrated and described herein in connection with FIGS. 10A-13B may be made of a non-stick lubricious compliant material such as PTFE or similar synthetic fluoropolymers of tetrafluoroethylene. PTFE is a hydrophobic, non-wetting, high density and resistant to high temperatures, and versatile material and non-stick properties. Moreover, the gap pads or plugs in each of the configurations illustrated and described herein in connection with FIGS. 10A-13B may be made of a polyimide material, and in one aspect, is made of a durable high-performance polyimide-based plastic known under the tradename VESPEL manufactured by DuPont, or other suitable polyimide, polyimide polymer alloy, or PET, PEEK, PEKK polymer alloy, for example.

Turning now to FIGS. 10A-10B, an electrode 1102 having a proximal end 1104 fixedly attached to a proximal end 1104 of a clamp arm 1100 and having a distal end 1106 opposite to the fixed end that is free to move or deflect is illustrated. FIG. 10A illustrates a clamp arm 1100 and FIG. 10B illustrates a electrode 1102, according to at least one aspect of the present disclosure. The electrode 1102 is adapted and configured for use with a combination ultrasonic/bipolar RF energy surgical device and is deflectable under load, where the electrode 1102 is one pole of an RF circuit and the ultrasonic blade is the opposite pole of the bipolar RF circuit. The electrode 1102 is fixed to the clamp jaw at the proximal end and is free to deflect at the distal end. Accordingly, throughout this disclosure the electrode 1102 may be referred to as a cantilever beam electrode or deflectable electrode.

Turning first to FIG. 10A, the clamp arm 1100 comprises an electrode 1102 attached at a proximal end 1104 of the clamp arm 1100. In one aspect, the electrode 1102 is attached to the proximal end 1104 of the clamp arm 1100 by welding or any other suitable means such as soldering, for example. This enables the electrode 1102 to more vertically at a distal end 1112 of the clamp arm 1100. The clamp arm 1100 comprise a clamp arm pad 1108 and a resilient plug 1110 located at the distal end 1106 of the clamp arm 1100.

Turning now to FIG. 10B, the electrode 1102 defines a plurality of apertures 1112 to receive a plurality of protruding elements 1114 (e.g., teeth) of the clamp arm pad 1108 therethrough. The electrode 1102 comprises a connection portion 1116 to attach the electrode 1102 to the proximal end 1104 of the clamp arm 1100. The electrode 1102 comprises a resilient plug 1110 at the distal end 1106 of the electrode 1102. In one aspect, the resilient plug 1110 is made of silicone or other suitable material. The electrode 1102 is made an electrically conductive metal suitable to transmit RF energy to the tissue. The electrode 1102 is one pole of the bipolar RF circuit and the ultrasonic blade is another pole of the bipolar RF circuit.

FIGS. 11A-11D illustrate an electrode having a proximal end fixedly attached to a proximal end of a clamp arm and having a distal end opposite to the fixed end that is free to move or deflect, according to at least one aspect of the present disclosure. The electrode is adapted and configured for use with a combination ultrasonic/bipolar RF energy surgical device and is deflectable under load, where the electrode is one pole of an RF circuit and the ultrasonic blade is the opposite pole of the bipolar RF circuit.

Turning first to FIG. 11A, there is shown an end-effector 1132 comprising a clamp arm 1120, a peripheral electrode 1122 defining an inner aperture 1125, and a connection pad 1124 isolated from a conductive portion of the peripheral electrode 1122 to attach the peripheral electrode 1122 to a proximal end of the clamp arm 1120, according to at least one aspect of the present disclosure. This view also shows a connection pad 1124 at a proximal end 1128 that is used to attach the peripheral electrode 1122 to the proximal end 1128 of the clamp arm 1120 (FIG. 11B). Also shown in this view is a portion of a clamp arm pad 1126 as seen through the aperture 1125. The peripheral electrode 1122 is fixed to the clamp arm 1120 at the proximal end and is free to deflect at the distal end. Accordingly, throughout this disclosure the electrode 1122 may be referred to as a cantilever beam electrode or as a deflectable electrode.

FIG. 11B is a top view of the peripheral electrode 1122 and a partial side view of the end-effector 1132, according to at least one aspect of the present disclosure. The peripheral electrode 1122 defines a perimeter and herein may be referred to as a peripheral electrode. Also shown in this view, is an ultrasonic blade 1134 and a gap “x” defined at a distal end 1130 of the end-effector 1132 and the peripheral electrode 1122. The gap “x” is set by the thickness of the connection pad 1124. The end-effector 1132 comprises a clamp arm 1120 that is configured to pivotally open and close to grasp and compress tissue between the clamp arm 1120 and the ultrasonic blade 1134. The peripheral electrode 1122 is fixedly attached to the proximal end 1128 of the clamp arm 1120 and is free to move or deflect at the distal end 1130 of the clamp arm 1120.

FIG. 11C is a side view of an end-effector 1154 comprising a clamp arm 1156 and an ultrasonic blade 1159 and a top view of a peripheral electrode 1140 configured to attach to a proximal end 1150 of the clamp arm 1156, according to at least one aspect of the present disclosure. The peripheral electrode 1140 comprises an electrically conductive portion 1142 and an electrically non-conductive portion 1144 disposed about an outer perimeter of the electrically conductive portion 1142. A space is defined between an outer edge of the electrically conductive portion of the peripheral electrode 1140 and an outer edge of the electrically non-conductive portion of the peripheral electrode 1140. The peripheral electrode 1140 defines an aperture 1152 sized and configured to receive a clamp arm pad 1158 therethrough. The peripheral electrode 1140 is fixed to the clamp arm 1156 at the proximal end and is free to deflect at the distal end. Accordingly, throughout this disclosure the peripheral electrode 1140 may be referred to as a cantilever beam electrode or deflectable electrode.

The peripheral electrode 1140 also comprises a connection pad 1146 configured to attach the peripheral electrode 1140 to the proximal end 1150 of the clamp arm 1156. The connection pad 1146 extends from the peripheral electrode. The electrically non-conductive portion 1144 of the peripheral electrode 1140 extends to the distal end 1148 to define a space between the proximal edge of the electrically non-conductive portion 1144 and the distal edge of the electrically conductive portion 1142. The clamp arm 1156 is configured to pivotally open and close about a pivot point 1157 to grasp and compress tissue between the clamp arm 1156 and the ultrasonic blade 1159. The peripheral electrode 1140 is fixed to the clamp jaw at the proximal end and is free to deflect at the distal end. Accordingly, throughout this disclosure the peripheral electrode 1140 may be referred to as a cantilever beam electrode or as a deflectable electrode.

The clamp arm 1156 comprises a clamp arm pad 1158 attached thereto. As the clamp arm 1156 is pivotally closed towards the ultrasonic blade 1159, the clamp arm pad 1158 is received through the aperture 1152 defined by the peripheral electrode 1140. The electrode 1140 is fixedly attached to the proximal end 1150 of the clamp arm 1156 and is free to move or deflect at the distal end 1148 of the clamp arm 1156.

FIG. 11D is a side view of an end-effector 1174 comprising a clamp arm 1176 and an ultrasonic blade 1179 and a top view of a peripheral electrode 1160 configured to attach to a proximal end 1170 of the clamp arm 1176, according to at least one aspect of the present disclosure. The peripheral electrode 1160 comprises an electrically conductive portion 1162 and an electrically non-conductive portion 1164 disposed about an outer perimeter of the electrically conductive portion 1162 except at a distal end 1168 of the peripheral electrode 1160 where the electrically conductive portion 1162 extends the entire distance to the edge 1169 of the electrically non-conductive portion 1164. The peripheral electrode 1160 defines an aperture 1172 sized and configured to receive a clamp arm pad 1178 therethrough. The peripheral electrode 1160 also comprises a connection pad 1166 configured to attach the peripheral electrode 1160 to the proximal end 1168 of the clamp arm 1176. The conductive portion 1162 of the electrode 1160 extends to the distal end 1168 where the electrically conductive and non-conductive portions 1162, 1164 overlap to the edge 1169 such that there is no space defined between the proximal edge of the non-conductive portion 1164 and the distal edge of the electrically conductive portion 1162.

The end-effector 1174 comprises a clamp arm 1176 that is configured to pivotally open and close about a pivot point 1177 to grasp and compress tissue between the clamp arm 1176 and the ultrasonic blade 1179. The clamp arm 1176 comprises a clamp arm pad 1178 attached thereto. As the clamp arm 1176 is pivotally closed towards the ultrasonic blade 1179, the clamp arm pad 1178 is received through the aperture 1172 defined by the peripheral electrode 1160. The electrode 1160 is fixedly attached to the proximal end 1170 of the clamp arm 1176 and is free to move or deflect at the distal end 1168 of the clamp arm 1176.

FIGS. 12A-12C illustrate a clamp arm 1180 comprising an electrode 1188 having a proximal end 1194 fixedly attached to a proximal end 1194 of the clamp arm 1180 and having a distal end 1196 opposite to the fixed end that is free to move or deflect, according to at least one aspect of the present disclosure. The electrode 1188 is adapted and configured for use with a combination ultrasonic/bipolar RF energy surgical device and is deflectable under load, where the electrode is one pole of the bipolar RF circuit and the ultrasonic blade is the opposite pole of the bipolar RF circuit. The electrode 1188 is fixed to the clamp arm 1180 at the proximal end and is free to deflect at the distal end. Accordingly, throughout this disclosure the electrode 1188 may be referred to as a cantilever beam electrode or as a deflectable electrode.

Turning first to FIG. 12A, the clamp arm 1180 comprises a jaw 1182, a clamp arm pad 1184, and an electrode 1188, according to at least one aspect of the present disclosure. A proximal end 1194 of the electrode 1188 is fixedly attached to a proximal end 1194 of the jaw 1182 to form a connection 1190. The distal end 1196 of the electrode 1188 is free to move or deflect. A plug 1186 is located at a distal end 1196 of the clamp arm 1180 to set a gap between the electrode 1188 and the ultrasonic blade (not shown). The jaw 1182 is pivotally opened and closed to grasp and compress tissue between the clamp arm pad 1184 and the ultrasonic blade (not shown).

FIG. 12B is a section view of the clamp arm 1180 viewed from the perspective of the distal end 1196 of the clamp arm 1180, according to at least one aspect of the present disclosure. This view shows the plug 1186 with no backing defining a gap 1194 between the top 1196 of the plug 1186 and the bottom 1198 of the clamp arm pad 1184. The plug 1186 protrudes below the electrode 1188 and the clamp arm pad 1184 to set the gap between the electrode 1188 and the ultrasonic blade (not shown).

FIG. 12C is a section view of the clamp arm pad 1184 with a backing 1197, according to at least one aspect of the present disclosure. The clamp arm pad 1184 protrudes through the electrode 1188.

FIG. 12D is a clamp arm 1200 comprising a clamp jaw 1202, a clamp arm pad 1204, and a deflectable cantilever electrode 1208, according to at least one aspect of the present disclosure. A proximal end 1214 of the deflectable cantilever electrode 1208 is fixedly attached to a proximal end 1204 of the clamp jaw 1202 to form a connection 1210. The distal end 1216 of the deflectable cantilever electrode 1208 is free to move or deflect. A plug 1206 is located at a distal end 1216 of the clamp arm 1200 to set a gap between the deflectable cantilever electrode 1208 and the ultrasonic blade (not shown). The jaw 1202 is pivotally opened and closed to grasp and compress tissue between the clamp arm pad 1204 and the ultrasonic blade (not shown). The deflectable cantilever electrode 1208 is fixed to the clamp jaw 1202 at the proximal end and is free to deflect at the distal end. Accordingly, throughout this disclosure the deflectable cantilever electrode 1208 may be referred to as a cantilever beam electrode or as a deflectable electrode.

FIGS. 13A-13B illustrate a clamp arm 1220 comprising an electrode 1228 and a clamp arm pad 1225, according to at least one aspect of the present disclosure. The electrode 1228 is fixed to the clamp arm 1220 at the proximal end and is free to deflect at the distal end. Accordingly, throughout this disclosure the electrode 1228 may be referred to as a cantilever beam electrode or as a deflectable electrode. The clamp arm 1220 also includes wear resistant pads 1230 configured to set a gap between the electrode 1208 and the ultrasonic blade (not shown). FIG. 13A shows the electrode 1228 in an unloaded undeflected state and FIG. 13B shows the electrode 1228 in a loaded deflected state. A proximal end 1222 of the electrode 1228 is fixedly attached to the proximal end 1224 of the clamp arm 1220. The distal end 1226 of the electrode 1228, opposite to the fixed end, is free to move or deflect when it is under load. The electrode 1228 is adapted and configured for use with a combination ultrasonic/bipolar RF energy surgical device and is deflectable under load, where the electrode 1228 is one pole of the bipolar RF circuit and the ultrasonic blade is the opposite pole of the bipolar RF circuit. The length of the electrode 1228 is selected to accommodate burn through of the clamp arm pad 1225.

FIGS. 14A-15B illustrate an electrode configuration with an end-of-life indicator, which could be sensed by a generator, to prompt device replacement, according to various aspects of the resent disclosure. Turning first to FIG. 14A, there is illustrated an end-effector 1240 comprising a clamp arm 1242 and an ultrasonic blade 1244, according to at least one aspect of the present disclosure. The clamp arm 1242 comprises an electrode 1246 configured with an end-of-life indicator which may be sensed by a generator to prompt device replacement. A proximal end 1254 of the electrode 1246 is fixedly attached at an anchor point 1250 on a proximal 1254 end of the clamp arm 1242. The clamp arm 1242 is rotatable about a pivot point 1252 to enable the clamp arm 1242 to pivotally open and close to grasp and compress tissue between the electrode 1246 and the ultrasonic blade 1244. The electrode 1246 is fixed to the clamp arm 1242 at the proximal end and is free to deflect at the distal end. Accordingly, throughout this disclosure the electrode 1242 may be referred to as a cantilever beam electrode or as a deflectable electrode. The electrode 1246 is adapted and configured for use with a combination ultrasonic/bipolar RF energy surgical device and is deflectable under load, where the electrode 1246 is one pole of the bipolar RF circuit and the ultrasonic blade 1244 is the opposite pole of the bipolar RF circuit.

An end-of-life indicator comprising a tail 1258 made of electrically conductive electrode material is added proximal 1254 to the electrode 1246 anchor point 1250. The tail 1258 will deflect towards the ultrasonic blade 1244 as the clamp arm pads and wear resistant pads 1248 show use wear and tear during a procedure. When the tail 1258 contacts the ultrasonic blade 1244 an electrical short circuit can be detected in the device to trigger the end of life of the device and notify the surgeon to replace and dispose of the device. The electrode 1246 is fixed to the clamp jaw at the proximal end and is free to deflect at the distal end. Accordingly, throughout this disclosure the electrode 1246 may be referred to as a cantilever beam electrode or as a deflectable electrode.

FIG. 14B shows the end-of-life indicator tail 1258 at the start of a procedure and FIG. 14C shows the end-of-life indicator tail 1258 at the end of the procedure. In FIG. 14B, the end-of-life indicator tail 1258 is not in contact with the ultrasonic blade 1244 indicating that the device is in good condition. In FIG. 14C, the end-of-life indicator tail 1258 is in contact with the ultrasonic blade 1244 causing an electrical short circuit at point 1260 to indicate that the device is at the end-of-life and needs to be replaced.

FIG. 15A illustrates an end-effector 1270 comprising a clamp arm 1272 and an ultrasonic blade 1274, according to at least one aspect of the present disclosure. The clamp arm 1272 comprises an electrode 1276 configured with an end-of-life indicator 1278 which may be sensed by a generator to prompt device replacement. The end-of-life indicator 1278 comprises a tail 1288 made of electrically conductive electrode material added proximal 1282 to the electrode 1276 anchor point 1284. A new wearable clamp arm pad 1280 is fixedly attached to the clamp arm 1272 and protrudes through apertures provided in the cantilever deflectable electrode 1276 (as shown and described, for example in FIGS. 1-9 ). A proximal end 1282 of the electrode 1276 is fixedly attached at an anchor point 1284 on a proximal 1282 end of the clamp arm 1272. The clamp arm 1272 is rotatable about a pivot point 1284 to enable the clamp arm 1272 to pivotally open and close to grasp and compress tissue between the electrode 1276 and the ultrasonic blade 1274. The electrode 1276 is fixed to the clamp arm 1272 at the proximal end and is free to deflect at the distal end. Accordingly, throughout this disclosure the electrode 1276 may be referred to as a cantilever beam electrode or as a deflectable electrode. The electrode 1276 is adapted and configured for use with a combination ultrasonic/bipolar RF energy surgical device and is deflectable under load, where the electrode 1276 is one pole of the bipolar RF circuit and the ultrasonic blade 1274 is the opposite pole of the bipolar RF circuit.

FIG. 15B illustrates the end-effector 1270 of FIG. 15A after the clamp arm pad is worn close to failure. As shown, the end-of-life indicator 1278 tail 1288 will deflect towards the ultrasonic blade 1274 as the clamp arm pads 1280 wear during a procedure and creates an electrical contact 1284 between the tail 1288 and the ultrasonic blade 1274. As shown, components 1290, 1292, 1294, 1296, 1298 of the clamp arm pad 1280 are noticeably worn relative to the clamp arm pad 1280 shown in FIG. 15B. The worn clamp arm pads 1290-1298 cause the tail 1288 to contact 1284 the ultrasonic blade 1244 causing an electrical short circuit that can be detected either by a generator or the device to trigger a device end of life notification to the surgeon to replace and dispose of the device. A warning in that regard may be provided to a video display to alert the surgeon or may be provided to a control circuit to trigger other actions.

FIGS. 16A-16B, 17, and 18A-18D illustrate configurations wherein the electrode can move vertically along its entire length, according to various aspects of the present disclosure. Turning first to FIG. 16A, which shows a clamp arm 1300 portion of an end-effector, according to at least one aspect of the present disclosure. The clamp arm 1300 comprises a floating electrode 1308 mounted to a spring 1310 such that the floating electrode 1308 can deflect in direction “d” along its entire length. The clamp arm 1300 comprises a lubricious clamp arm pad 1302 and a wear resistant clamp arm pads 1304, 1306 mounted into the lubricious clamp arm pad 1302. The wear resistant clamp arm pads 1304 are used to set a gap between the floating electrode 1306 and the ultrasonic blade (not shown). For conciseness and clarity of disclosure, the ultrasonic blade portion of the end-effector is not shown. As disclosed herein, the lubricious clamp arm pad 1302 is made of a non-stick lubricious material such as PTFE or similar synthetic fluoropolymers of tetrafluoroethylene, for example, and the wear resistant clamp arm pads 1304, 1306 are made of polyimide materials such as VESPEL, PET, PEEK, or PEKK for example. The electrode 1306 is adapted and configured for use with a combination ultrasonic/bipolar RF energy surgical device and is deflectable under load, where the electrode 1306 is one pole of the bipolar RF circuit and the ultrasonic blade is the opposite pole of the bipolar RF circuit.

Turning now to FIG. 16B, the wear resistant clamp arm pad 1304 is mounted to an end of the lubricious clamp arm pad 1302 to help reduce wear of the lubricious clamp arm pad 1302.

FIG. 17 illustrates a portion of an end-effector 1320 comprising a clamp arm 1322, according to at least one aspect of the present disclosure. The clamp arm 1322 comprises a floating electrode 1324 mounted to a resilient clamp arm pad 1326 such that the floating electrode 1324 can deflect in direction “d” along its entire length. The clamp arm 1322 comprises a plurality of wear resistant clamp arm pads 1328 mounted to the resilient clamp arm pad 1326. The wear resistant clamp arm pads 1328 are used to set a gap between the floating electrode 1324 and the ultrasonic blade (not shown). For conciseness and clarity of disclosure, the ultrasonic blade portion of the end-effector is not shown. The resilient clamp arm pad 1326 acts as a spring that the floating electrode 1324 can deflect into the resilient clamp arm pad 1326 and move in direction “d”. The wear resistant clamp arm pads 1328 set the tissue gap between the floating electrode 1324 and the ultrasonic blade (not shown). As disclosed herein, the lubricious clamp arm pad 1326 is made of a non-stick lubricious material such as PTFE or similar synthetic fluoropolymers of tetrafluoroethylene, for example, and the wear resistant clamp arm pad 1328 are made of polyimide materials such as VESPEL, PET, PEEK, or PEKK for example. The electrode 1324 is adapted and configured for use with a combination ultrasonic/bipolar RF energy surgical device and is deflectable under load, where the electrode 1324 is one pole of the bipolar RF circuit and the ultrasonic 1334 blade is the opposite pole of the bipolar RF circuit.

FIG. 18A is a section view of an end-effector 1330 comprising a clamp arm 1332, according to at least one aspect of the present disclosure. The end-effector comprises a clamp arm 1332 and an ultrasonic blade 1334. The clamp arm comprises an electrode 1136, a resilient clamp arm pad 1338, and a plurality of wear resistant dowel pins 1340. The wear resistant dowel pins 1340 set the tissue gap “G” between the ultrasonic blade 1334 and the electrode 1336.

FIG. 18B is a section view of the end-effector 1330 showing the location of the wear resistant dowel pins 1340 in the clamp arm 1332. This view also shows the relative position of the resilient clamp arm pad 1336 relative to the wear resistant dowel pins 1340 and the electrode 1336.

FIG. 18C is a section view of a wear resistant dowel pin 1340′, according to at least one aspect of the present disclosure. The dowel pin 1340′ includes barb features 1342 to prevent the wear resistant dowel pin 1342′ from backing out after it is installed in the clamp arm 1332.

FIG. 18D is a section view of a wear resistant dowel pin 1340″, according to at least one aspect of the present disclosure. The dowel pin 1340″ includes a pierce feature 1344 to prevent the wear resistant dowel pin 1342″ from backing out after it is installed in the clamp arm 1332.

FIG. 19A illustrates a portion of an end-effector 1350 comprising a clamp arm 1352 comprising an electrode 1354 with a “center pivot” configuration, according to at least one aspect of the present disclosure. The electrode 1354 can rotate about a pivot point 1356 near the mid-point of the electrode 1354. The electrode 1354 is adapted and configured for use with a combination ultrasonic/bipolar RF energy surgical device and is deflectable under load, where the electrode is one pole of the bipolar RF circuit and the ultrasonic blade is the opposite pole of the bipolar RF circuit.

FIG. 19B illustrates a portion of an end-effector 1360 comprising a clamp arm 1362 comprising an electrode 1364 with a “center pivot” configuration, according to at least one aspect of the present disclosure. The electrode 1364 can rotate about a pivot point 1366 near the mid-point of the electrode 1364.

FIGS. 20-27 show various design elements for the spring, electrode, and wear pads which could be incorporated into any of the configurations shown in FIGS. 10A-19B. The electrodes is adapted and configured for use with a combination ultrasonic/bipolar RF energy surgical device and is deflectable under load, where the electrode is one pole of the bipolar RF circuit and the ultrasonic blade is the opposite pole of the bipolar RF circuit.

FIG. 20 illustrates an end-effector 1370 comprising a clamp arm 1372 and an ultrasonic blade 1374, according to at least one aspect of the present disclosure. The clamp arm 1372 comprises a spring element 1380 formed into an electrode 1376. Wear pads 1378 are attached to the electrode 1376 on a side facing the ultrasonic blade 1374. In another aspect, the electrode 1376 formed into a spring 1380 may further comprise strips of metal to form a leaf spring configuration.

FIG. 21 illustrates a spring element 1382 formed into an electrode 1384, according to at least one aspect of the present disclosure. The spring element 1382 includes tabs 1386 bent at the electrode 1384. A wear pad 1388 is attached to the spring element 1382.

FIGS. 22A-22C illustrates a clamp arm 1390 comprising a wave spring element 1392 supporting an electrode 1394, according to at least one aspect of the present disclosure. The clamp arm 1390 further comprises a resilient wear clamp arm pad 1396. The wave spring element 1392 is positioned such that the electrode 1394 can deflect in direction “d”. In another aspect, wear resistant clamp arm pads (not shown) may be added to the clamp arm 1390.

FIG. 22A illustrates one aspect of the clamp arm 1390 where the wave spring element 1392 is formed integral with the resilient clamp arm pad 1396 to deflect the electrode 1392 in direction “d”. FIG. 22B illustrates one aspect of a clamp arm 1398 where the wave spring element 1392 is positioned between the resilient clamp arm pad 1396 and the electrode 1394 to deflect the electrode 1392 in direction “d”. FIG. 22C illustrates one aspect of a clamp arm 1399 where the wave spring element 1392 also is formed integral with the resilient clamp arm pad 1396 to deflect the electrode 1392 in direction “d”.

FIGS. 23A-23B illustrate electrode 1400 attachment methods, according to various aspects of the present disclosure. In FIG. 23A the electrode 1400 is disposed through protrusions 1402 in the clamp arm pad 1404 and attached to the clamp arm by a bracket 1406. In FIG. 23B the electrode 1400 is attached to the clamp arm pad 1402 by a cylindrical spring 1408.

FIGS. 24A-24C illustrate electrode spring element configurations, according to various aspects of the present disclosure. FIG. 24A illustrates an end-effector 1410 comprising a clamp arm 1412 and an ultrasonic blade 1414, according to at lease one aspect of the present disclosure. The clamp arm 1412 comprises an electrode 1416 overmolded with an elastomer 1418, thus removing the need for a spring. The electrode 1416 is attached to the clamp arm 1412 by electrically conductive connections 1418. Wear resistant pads 1420 are disposed on the surface of the electrode 1416. The configuration shown in FIG. 24A provide uniform compression along the length of the electrode 1416. Electrical contact is made through the sides. The spring rate increase as it compresses against the elastomer 1418.

In other aspects, overmolded rings or pads may be provided on the ultrasonic blade 1414 in place of the wear resistant pads 1420 disposed on the surface of the electrode 1416. In another aspect, the electrode 1416 may be configured to sink into material that displaced due to a heated ultrasonic blade 1414.

FIG. 24B illustrates a clamp arm 1430 comprising a diaphragm electrode 1432, according to at least one aspect of the present disclosure. For conciseness and clarity of disclosure, the ultrasonic blade 1414 (FIG. 254A) is not shown in this view. The diaphragm electrode 1432 is attached to the clamp arm 1430 by rigid electrically conductive connections 1434. The clamp arm pads 1436 are disposed on the diaphragm electrode 1432. The diaphragm electrode 1432 can be formed of a thinner metallic conductor material to flex or deflect the electrode 1432. In one aspect, the diaphragm electrode 1432 can be made in the form of a ring. The rigid connections 1434 to the clamp arm 1430 ensure electrical path. The configuration shown in FIG. 24B reduce chances of the electrode 1432 binding.

FIG. 24C illustrates a clamp arm 1440 comprising a one piece spring electrode 1442, according to at least one aspect of the present disclosure. For conciseness and clarity of disclosure, the ultrasonic blade 1414 (FIG. 254A) is not shown in this view. The one piece spring electrode 1442 includes ends 1444 folded into springs similar in shape to formed staples. The one piece spring electrode 1442 is low cost and reduces transitions in the electrical path. As shown in FIG. 24C, the curved ends 1444 of the one piece spring electrode 1442 are in electrical communication with the clamp arm 1440 at connections 1446. Clamp arm pads 1448 are disposed on the one piece spring electrode 1442.

FIG. 25 illustrates an electrode 1450 comprising a coined bump 1452 for use with integral wear pads (not shown), according to at least one aspect of the present disclosure. The coined bump 1452 is coated with an electrically insulative material 1454 to prevent shorting against the ultrasonic blade (not shown). The coined bump 1452 allows for larger springs 1456 to deflect the electrode 1450.

Following is a description of construction techniques for electrodes, pads, and springs as described herein. In one aspect, a backing may be located under the electrode. A fine blank of 300 SST may be employed with secondary machining to meet tolerances for guiding the electrode up and down and injection molding. In another aspect, the clamp arm pads may be made of silicone or plastic. The silicone or plastic clamp arm pad material may be injection molded onto the electrode. A through hole may be formed through the electrode to anchor the silicone or plastic material.

Springs 1460 as shown in FIG. 26 are tested under heat and tissue fluid conditions, according to at least one aspect of the present disclosure. The length of the spring 1460 may be increased. In one aspect, the spring 1460 may a high temperature stainless steel coil spring. In another aspect, a PTFE clamp arm pad can be broken into more than one piece to allow room for the length of the spring 1460 to increase. The PTFE clamp arm pad can be machined. In one aspect, the clamp arm pad may be modified to remove pad material underneath the spring.

With reference to FIG. 27 , to prevent binding of the electrode 1464 as it deflects up and down, the distance “d1” of the electrode may be increased, according to at least one aspect of the present disclosure.

FIGS. 28A-31 illustrate an end-effector 1470 configured with one or more than one resistor 1480 embedded (integrated) in a clamp arm pad 1478 to sense the height “h” of the clamp arm pad 1478, according to at least one aspect of the present disclosure. The end-effector 1470 comprises a clamp arm 1472, and an ultrasonic blade 1474, an electrode 1476, a clamp arm pad 1478, and one or more than one resistor 1480 embedded in the clamp arm pad 1478. The resistors 1480 melt or wear along with the clamp arm pad 1478 such that the resistance value of the resistors 1480 is analogous to the height of the clamp arm pad 1478. Accordingly, the value of the resistor 1480 may be employed to infer the height of the clamp arm pad 1478 in real-time, the melt rate of the clamp arm pad 1478, or provide a warning signal or recommendation, or combinations thereof. The user or control circuit may employ the warning signal or recommendation to determine next steps. The warning signals are conveyed to a control circuit coupled to one or more than one the resistor 1480 via electrical conductors 1482. The electrode is adapted and configured for use with a combination ultrasonic/bipolar RF energy surgical device and is deflectable under load, where the electrode is one pole of the bipolar RF circuit and the ultrasonic blade is the opposite pole of the bipolar RF circuit.

In FIG. 28A, the clamp arm pad 1478 is new and does not show any wear and the resistors 1480 and the clamp arm pad 1478 are whole and indicate a full resistance value at full height h₁ with no tissue between the clamp arm 1472 and the ultrasonic blade 1474. FIG. 28B illustrates the end-effector 1470 with no tissue between the clamp arm 1472 and the ultrasonic blade 1474 and with the clamp arm pad 1478 and resistors 1480 worn to a height of h₂, which is less than h₁ due to heat 1484 generated by friction between the clamp arm 1472 and the ultrasonic blade 1474 and the resistors 1480. As the resistors 1480 are worn, the resistance level changes, e.g., may increase or decrease depending on the actual implementation, and is communicated to a control circuit via the electrical conductors 1482 coupled to the resistors 1480. One example of a resistance level R of the resistor 1480 in clamp arm pad 1478 versus pad height “h” is illustrated in FIG. 29 , as described hereinbelow. As shown in FIG. 28B, the warning signal is provided when the melt rate of the clamp arm pad 1478 is too rapid and exceeds a predetermined threshold due in part because there is no tissue between the clamp arm 1472 and the ultrasonic blade 1474.

FIGS. 28C-28D illustrate the condition where the electrode 1476 is deflected to a height of h₃, which is less than h₁, due to thick tissue 1490 located between the clamp arm 1472 and the ultrasonic blade 1474. The thick tissue 1490 pushes down on the electrode 1476 with a force 1488. In this configuration, the clamp arm pad 1478 is still at full height h₁ or above the warning threshold and the resistance level also is at full value or above

FIG. 29 is a graphical illustration 1500 of one example of a resistance level R of the resistor 1480 in clamp arm pad 1478 versus pad height “h”, according to at least one aspect of the present disclosure. As described in connection with FIGS. 28A-28D, the measure of resistance level (R1-R5), shown along the vertical axis, will vary in accordance with pad height “h” from low to high, as shown along the horizontal axis. As shown in FIG. 29 , a resistance between level between R1 and R2 indicates a warning that the clamp arm pad 1472 is 50% worn, a resistance level between R2 and R3 indicates a warning signal to replace the clamp arm pad 1472 soon, and a resistance level between R3 and R4 indicates a warning signal to shut off energy to the ultrasonic blade 1474 or the device at large. As shown in FIG. 29 , the resistance level R of the resistor 1480 increases as the height “h” of the clamp arm pad 1478 decreases. As shown, the curve is exponential. In various other aspects, the electrical circuit may be configured such that the curve is linear and/or the resistance level R of the resistor 1480 decreases as the height “h” of the clamp arm pad 1478 decreases, without limitation.

FIGS. 30A-30B illustrate the resistance level (R1-R5) as a function of the height “h” of the resistor 1480 and analogously the height “h” of the clamp arm pad 1478 because the resistor 1480 is embedded in the clamp arm pad 1478 and both elements will wear at the same rate. FIG. 30A shows the end-effector 1470 with a new clamp arm pad 1478 and resistor 1480 mounted in the clamp arm 1472. As shown, the ultrasonic blade 1474 is in contact with wear resistant pads 1508 which set the minimum gap between the electrode 1476 and the ultrasonic blade 1474. The clamp arm pad 148 is at full height “h” or at least above a minimum warning threshold and is in contact with the ultrasonic blade 1474. In this configuration, the resistor 1480 also is at a resistance level below the minimum warning threshold R1.

FIG. 30B illustrates the state of the end-effector 1470 when the clamp arm pad 1478 is slightly worn to indicate a resistance level R2. At the resistance level R2, the warning signal is approaching an indication to replace the clamp arm pad soon as shown in the graph 1500 in FIG. 29 .

FIG. 31 is a graphical illustration 1510 of clamp arm pad 1478 height “h”, as measured by an integrated resistor 1480, shown along the vertical axis, as a function of time “t”, shown along the horizontal axis, according to at least one aspect of the present disclosure. During a first period t₁, the warning signal indicates a good condition due to the clamp arm pad 1478 height “h” as measured by the integrated resistor 1480. The clamp arm pad 1478 may be high due to either a new pad or a pad with a very low melt rate due to tissue being located between the clamp arm 1472 and the ultrasonic blade 1474. During a second period t₂, the warning signal indicates a bad condition because the jaw is empty with no tissue located between the clamp arm 1472 and the ultrasonic blade 1474. A bad warning signal is issued to unclamp the clamp arm 1472. This condition is detected based on the rate of change of the resistance of the integrated resistor 1480 over time as indicated by slopes S₁, S₂. During a third period t₃, when tissue is reintroduced between the clamp arm 1472 and the ultrasonic blade 1474, the warning signal once again indicates a good condition based on the measured resistance value of the integrated resistor 1480 and the slope S₃. Once again, during a fourth period t₄, the warning signal indicates a bad condition because the jaw is empty with no tissue located between the clamp arm 1472 and the ultrasonic blade 1474. The issued warning signal indicates to either unclamp the clamp arm 1472 or temporarily shut-off energy to the ultrasonic blade 1474 or the device. This bad condition is detected based on the rate of change of resistance 1478 over time and is indicated by S₄. In period t₅, the warning signal once again indicates a good condition based on the measured value of the integrated resistor 1480.

FIGS. 32-33B illustrate configurations wherein the electrode can pivot near the mid-point of the electrode, according to at least one aspect of the present disclosure. FIG. 32 is an exploded view of a clamp arm 1520 comprising a center pivoting electrode 1522, according to at least one aspect of the present disclosure. The center pivoting electrode 1522 is fixed to a non-conductive rocker support 1524 at snap fit joints labeled A, B, C, D. The non-conductive rocker support 1524 is pivotally attached to a clamp arm jaw 1526 at a rocker pivot point D′. The center pivoting electrode 1522 comprises a plurality of electrically non-conductive pads 1528 to set a gap between the center pivoting electrode 1522 and the ultrasonic blade 1532 shown in FIGS. 33A-33B. The center pivoting electrode 1522 is coupled to an RF generator via electrical conductor 1534. The electrode 1522 is adapted and configured for use with a combination ultrasonic/bipolar RF energy surgical device and is deflectable under load, where the electrode 1522 is one pole of the bipolar RF circuit and the ultrasonic blade 1532 is the opposite pole of the bipolar RF circuit.

FIGS. 33A-33B illustrate an end-effector 1530 comprising the clamp arm 1520 shown in FIG. 32 and an ultrasonic bade 1532, according to at least one aspect of the present disclosure. In FIG. 33A, the pads 1526 are new such that at full clamp the center pivoting electrode 1522 is a predetermined angle (e.g., parallel) relative to the clamp arm jaw 1526. As the pads 1528 wear downs, as shown in FIG. 33B, and in order to maintain a consistent gap between the ultrasonic blade 1532, the angle θ between the center pivoting electrode 1522 relative to the clamp arm jaw 1526 will change.

In one aspect, the present disclosure provides interlocking pad features to allow a clamp arm pad to fixate an electrode to a clamp arm support.

FIGS. 34-35C illustrate one aspect of interlocking clamp arm pads and electrode plates that act as both the restraining system and the ultrasonic support. In one aspect, the clamp arm may comprise a longitudinally aligned slot from a proximal end through which an electrode plate may be advanced without the clamp arm pad material. Once fully inserted, the clamp arm pad material pillars may be inserted from a distal end deflecting the electrode plate until they snap into position. Once interlocked together, the backside of the clamp arm pad material component prevents further proximal or distal longitudinal motion of the electrode and the front of the clamp arm pad material extending through the electrode openings form an ultrasonic blade clamp arm support. The electrode is adapted and configured for use with a combination ultrasonic/bipolar RF energy surgical device and is deflectable under load, where the electrode is one pole of the bipolar RF circuit and the ultrasonic blade is the opposite pole of the bipolar RF circuit.

FIG. 34 is a perspective section view of a clamp arm 1540 comprising a longitudinally aligned slot 1542 from a proximal end 1556 through which an electrode plate 1544 may be advanced without the clamp arm pad 1546 material, according to at least one aspect of the present disclosure. The electrode plate 1544 defines apertures 1548 to receive protrusion elements 1550 of the clamp arm pad 1546. The clamp arm pad 1546 is disposed above a clamp jaw 1552 of the clamp arm 1540.

FIG. 35A is a section view of the clamp arm 1540 shown in FIG. 34 prior to assembly. Initially, the clamp arm pad 1546 is interlocked into the underside of the electrode plate 1544 by inserting the protruding elements 1550 of the clamp arm pad 1546 into the apertures 1548 defined by the electrode plate 1544 in the direction indicated by the arrows to form a clamp arm pad/electrode plate assembly 1560. A tab 1554 provided at the proximal end 1556 of the clamp arm pad 1546 is received or snapped into a proximal recess 1558 provided at the proximal end of the 1556 of the clamp arm 1540.

In FIG. 35B the clamp arm pad/electrode plate assembly 1560 is slid proximally 1556 into the longitudinally aligned slot 1542 defined by the clamp jaw 1552. In FIG. 35C the tab 1554 at the proximal end 1556 of the clamp arm pad 1546 locks into the proximal recess 1558 defined by the proximal end 1556 of the clamp jaw 1552 interlocking the clamp arm pad/electrode plate assembly 1560 with the clamp jaw 1552.

In one aspect, the present disclosure provides a continuous spring support member for a deflectable combo device electrode. FIG. 36 illustrates one aspect of a continuous spring support disposed under the electrode rather than a discrete spring attached at one end of the electrode. In one aspect, an electrode may be attached to a clamp arm support via a wave spring 1570 mechanism along the entire underside of the electrode, as show in FIG. 36 . The wave spring 1570 could be a perimeter concentric oval around the electrode or could be comprised of multiple nested deflectable structures. The wave spring 1570 can be made of plastic (non-conductive) or can be electrically insulated from the electrode by a polymer, which could also be used for attachment.

In another aspect, the present disclosure provides a laterally deflectable electrode to create blade seating location. FIGS. 37-50 illustrate a laterally deflectable/parting electrode, according to various aspects of the present disclosure. In various aspects, the present disclosure provides a deflectable pad that spreads laterally when pressure applied by an ultrasonic blade exceeds a predefined level causing the electrode to separate and prevent direct contact between the electrode and the ultrasonic blade. The electrode is adapted and configured for use with a combination ultrasonic/bipolar RF energy surgical device and is deflectable under load, where the electrode is one pole of the bipolar RF circuit and the ultrasonic blade is the opposite pole of the bipolar RF circuit.

The electrode can be supported to deflect both vertically and laterally by fixating the proximal end and creating an elastomer connection between a right and left section of the electrode which are in electrical connection with each other. As the clamp arm pad deflects away from the ultrasonic blade due to interaction between the polyamide pad and the ultrasonic blade a feature on the upper surface of the underlying clamp arm support has a distal wedge feature that separates the right and left sides at the distal end as the pad is deflected more vertically preventing contact between the blade and the electrode while allowing a zero gap state.

Thermal expansion properties of the clamp arm pad may be utilized as it is heated (10%-20%) to induce the lateral expansion. Laterally expanding electrodes also can be produced by utilizing the thermal expansion properties of the clamp arm pad due to both heat and compression by the ultrasonic blade. This can in-turn induce lateral spacing increase between the electrodes driving them out of the path of the ultrasonic blade.

FIG. 37 is a perspective view of an end-effector 1580 comprising a laterally deflectable electrode 1582, forming one pole of the electrosurgical circuit, and an ultrasonic blade 1586, forming the other pole of the electrosurgical circuit, according to at least one aspect of the present disclosure. The end-effector 1580 comprises a clamp arm 1584 coupled to the laterally deflectable electrode 1582 by any suitable fastener 1583 or fastening technique such as welding, laser welding, brazing, soldering, pressing, among other fastening techniques. The end-effector 1580 further comprises a clamp arm pad 1588. In FIG. 37 the laterally deflectable electrode 1582 is shown in the undeflected state.

FIG. 38 shows the laterally deflectable electrode 1582 in an undeflected state (shown in solid line) and in a deflected state 1582′ (shown in broken line), according to at least one aspect of the present disclosure. The laterally deflectable electrode 1582 may be deflected by material clamped between the clamp arm 1584 and the ultrasonic blade 1586 or by the ultrasonic blade 1586 alone.

FIG. 39 is a section view of an end-effector 1600 comprising an electrode 1602 as a structural clamping member, forming one pole of the electrosurgical circuit, and an ultrasonic blade 1606, forming the other pole of the electrosurgical circuit, according to at least one aspect of the present disclosure. The electrode 1602 is inward facing about a clamp arm pad 1604. The electrode 1602 also comprises a vertical stiffening form 1607.

FIG. 40 is a section view of an end-effector 1608 comprising an electrode 1610 as a structural clamping member, forming one pole of the electrosurgical circuit, and an ultrasonic blade 1612, forming the other pole of the electrosurgical circuit, according to at least one aspect of the present disclosure. The electrode 1610 is inward facing about a clamp arm pad 1611. The electrode 1610 also comprises a vertical stiffening form 1613.

FIG. 41 is a section of an end-effector 1614 comprising an electrode 1616 as a structural clamping member, forming one pole of the electrosurgical circuit, and an ultrasonic blade 1622, forming the other pole of the electrosurgical circuit, according to at least one aspect of the present disclosure. The electrode 1616 is coupled to a clamp arm 1618 and is inward facing below the clamp arm 1618 to couple to a clamp arm pad 1620. The clamp arm 1618 also comprises a vertical stiffening form 1624 to secure the electrode 1616 to the clamp arm 1618. In FIG. 41 the electrode 1616 is shown in its undeflected state.

In FIG. 42 the electrode 1616 is shown in its laterally deflected state 1616′ (shown in broken line), according to at least one aspect of the present disclosure. Thermal expansion of the clamp arm pad 1620 forces the electrode 1616 to deflect or expand laterally and away from the ultrasonic blade 1622 and the clamp arm pad 1620. The lateral expansion of the electrode 1616 widens or extends considerably to the expanded clamp arm pad 1620′ (shown in broken line) when the clamp arm pad material (e.g., PTFE) transitions to a gel-like state at or near 330° C. Deformation is due to compressive clamp load.

FIGS. 43-44 illustrate examples of clamp arms comprising laterally expanding electrodes where the original state of the clamp arm is shown in solid lime and the expanded state is shown in broken line. FIG. 43 illustrates a clamp arm 1630 comprising a laterally deflectable electrode 1632, forming one pole of the electrosurgical circuit, according to at least one aspect of the present disclosure. The clamp arm 1630 is configured for use with an end-effector comprising an ultrasonic blade forming the other pole of the electrosurgical circuit, according to at least one aspect of the present disclosure. The clamp arm 1630 comprises a clamp jaw 1636 coupled to the laterally deflectable electrode 1632 by any suitable fastening technique such as welding, laser welding, brazing, soldering, pressing, among other fastening techniques. The clamp arm 1630 further comprises a clamp arm pad 1638. The undeflected state is shown in solid line and the laterally deflected state of the components is shown in broken line.

FIG. 44 illustrates a clamp arm 1640 comprising a laterally deflectable electrode 1642, forming one pole of the electrosurgical circuit, according to at least one aspect of the present disclosure. The clamp arm 1640 is configured for use with an end-effector comprising an ultrasonic blade forming the other pole of the electrosurgical circuit, according to at least one aspect of the present disclosure. The clamp arm 1640 comprises a clamp jaw 1646 coupled to the laterally deflectable electrode 1642 by any suitable fastening technique such as welding, laser welding, press pins, among other techniques. The end-effector 1640 further comprises a clamp arm pad 1648. The undeflected state is shown in solid line and the laterally deflected state of the components is shown in broken line.

FIGS. 45-46 illustrate an end-effector 1650 comprising a laterally deflectable electrode 1652, forming one pole of the electrosurgical circuit, and an ultrasonic blade 1654, forming the other pole of the electrosurgical circuit, according to at least one aspect of the present disclosure. The end-effector 1650 comprises a clamp arm 1656 coupled to the laterally deflectable electrode 1652 by any suitable fastening technique such as welding, laser welding, brazing, soldering, pressing, among other fastening techniques. The end-effector 1650 further comprises a clamp arm pad 1658. The undeflected state of the electrode 1652 is shown in FIG. 45 with a distance d between the center of the electrode 1652 to the most lateral extension of the electrode 1652. The laterally deflected state of the electrode 1652 is shown in FIG. 46 with a distance d′ between the center of the electrode 1652 to the most lateral extension of the electrode 1652. The lateral deflection of the electrode 1652 is due primarily to the thermal expansion and mechanical deformation, which is largely lateral. The thermal expansion and mechanical deformation forces the electrode 1652 away from the ultrasonic blade 1654, where d′>d. This is particularly true when the clamp arm pad 1658 material (e.g., PTFE) reaches a gel-like state at about 330° C. The clamp arm 1654 also comprises a vertical stiffening form 1655 to secure the electrode 1652 to the clamp arm 1654.

FIGS. 47-50 illustrate and end-effector 1660 comprising a laterally deflectable electrode 1662, forming one pole of the electrosurgical circuit, and an ultrasonic blade 1664, forming the other pole of the electrosurgical circuit, according to at least one aspect of the present disclosure. The end-effector 1660 comprises a clamp arm 1666 coupled to the laterally deflectable electrode 1662 by any suitable fastener 1663 or fastening technique such as welding, laser welding, brazing, soldering, pressing, among other fastening techniques. The end-effector 1660 further comprises a clamp arm pad 1668. The laterally deflectable electrode 1662 includes a notch 1670 defined on a distal end 1672. FIG. 49 illustrates the lateral deflection of the laterally deflectable electrode 1662 in broken line in the direction of the arrows 1669. FIG. 50 is a magnified view of the laterally deflectable electrode 1662 where the lateral deflection is shown in broken line.

FIGS. 51-58 illustrate an end-effector 1671 comprising a pair of metal clamp arms 1673 a, 1673 b coated with a compliant or deformable dielectric material 1675, and a wire electrode 1674, according to at least one aspect of the present disclosure. The compliant or deformable dielectric material 1675, such as silicone rubber, shrink tubing, or similar material is disposed over each of the metal clamp arms 1673 a, 1673 b. The metal clamp arms 1673 a, 1673 b may be made of stainless steel, titanium, or similar metals, or alloys thereof. The wire electrode 1674 is attached to one of the metal clamp arms 1673 a. The wire electrode 1674 may be made of a metal such as stainless steel, titanium, or similar metals, or alloys thereof, with either a bare metal finish or coated with a thin dielectric material such as PTFE or coated and skived to reveal a very thin bare metal strip.

As shown in FIG. 55 , the compliant or deformable dielectric material 1675 can be the same material (e.g., silicone) or can be a harder or softer material, according to at least one aspect of the present disclosure. For example, a rigid PTFE tubing on one side or the other matched against a silicone rubber on the opposite side.

As shown in FIG. 56 , the metal clamp arms 1673 a, 1673 b can be implemented as bipolar electrodes by adding outer electrodes 1677 a, 1677 b, according to at least one aspect of the present disclosure.

As shown in FIGS. 57-58 , the metal clamp arms 1673 a, 1673 b can be bare metal or coated/covered metal such as, for example, a stainless steel structural member with a PTFE shrink tubing 1679 (thin walled) on an interior surface thereof, according to at least one aspect of the present disclosure.

Additional background disclosure may be found in U.S. Patent Application Publication Nos. 2016/0206367, 2017/0164997, 2015/0148834, which are herein incorporated by reference in their entirety.

In one aspect, the present disclosure provides asymmetric cooperation of the clamp arm/electrode/pad to effect the ultrasonic blade-RF electrode interaction. In one aspect, the present disclosure provides a shortened clamp arm. FIGS. 10-12 illustrate an effector comprising a shortened clamp arm for deflectable/cantilever electrode applications, according to various aspects of the present disclosure. In one aspect, the end-effector is configured for asymmetric cooperation of the clamp arm, electrode, and clamp arm pad to effect the ultrasonic blade/RF electrode interaction. The electrode is adapted and configured for use with a combination ultrasonic/bipolar RF energy surgical device and is deflectable under load, where the electrode is one pole of the bipolar RF circuit and the ultrasonic blade is the opposite pole of the bipolar RF circuit.

In one aspect, a distal end of the clamp arm is shortened and a length of the clamp arm pad is kept the same length such that a distal end of the clamp arm pad extends beyond the distal end of the clamp arm. This would allow the electrode to hyper-extend to minimize potential for electrically shorting the distal end of the clamp arm. It also may have the benefit of extending the life of the clamp arm pad because of the additional exposed clamp arm pad material to be worn through. This configuration also can eliminate the use of the distal and middle gap setting clamp arm pads, previously referred to herein, for example, as wear resistant clamp arm pads for setting and maintaining a gap between the electrode and the ultrasonic blade.

FIG. 59 is a side view of an end-effector 1680 comprising a shortened clamp arm 1682, an ultrasonic blade 1684, an electrode 1686, and a clamp arm pad 1688, according to at least one aspect of the present disclosure. FIG. 60 is a top view of the end-effector 1680. As shown in FIGS. 59-60 , the ultrasonic blade 1684 and the electrode 1686 are substantially the same length. The clamp arm 1682 is shortened to allow the electrode 1686 to overextend to prevent an electrical short circuit. In one aspect, a gap setting pad 1690 is provided at a proximal end 1692 of the end-effector 1680.

FIG. 61 illustrates a clamp arm 1700 comprising a clamp jaw 1702, an electrode 1704, and a clamp arm pad 1706, according to at least one aspect of the present disclosure. Free up space distally on clamp arm. The clamp arm 1700 is configured for use with an end-effector comprising an ultrasonic blade as disclosed in other sections herein. This configuration frees up space distally 1708 on the clamp jaw 1702. The clamp arm pad 1706 (e.g., PTFE) is fully supported underneath, but space is freed in the t-slot region and on the side walls to allow for more clamp arm pad 1706 burn through and further deflection of the electrode 1704 away from the ultrasonic blade (not shown).

In one aspect, the present disclosure provides an end-effector that employs the thermal behavior of the pad to deflect the electrode. In one aspect, the length of the clamp arm pad may be the same length as the ultrasonic blade and as the clamp arm pad expands or changes shape due to pressure or heat, the thermal expansion properties of the clamp arm pad material (e.g., PTFE) can be used to deflect the electrode out of the path of the ultrasonic blade.

In one aspect, a non-biased electrode and pad are provided. The non-biased but deflectable pad varies in position with respect to the clamp arm as the pad wears. The non-biased electrode is configured to minimize contact between the ultrasonic blade and the RF electrode. The clamp arm pad comprises a feature for securing the electrode to the clamp arm pad. In one aspect, as the height of the clamp arm pad wears or is cut through, the height of the electrode with respect to the clamp arm is progressively adjusted. In another aspect, once the clamp arm is moved away from the ultrasonic blade the electrode remains in its new position. The electrode is fixed to the clamp arm at the proximal end and is free to deflect at the distal end. Accordingly, throughout this disclosure the electrode may be referred to as a cantilever beam electrode or as a deflectable electrode.

Configurations of end-effectors comprising a deflectable/cantilever electrode described hereinabove with respect to FIGS. 1-61 may be combined with a biased electrode as described hereinbelow with respect to FIGS. 62-67 .

In one aspect, the present disclosure provides an end-effector for a combination ultrasonic/bipolar RF energy surgical device that employs pressure or clamp jaw compression to adjust the height of the electrode as the clamp arm pad wears. In one aspect, the clamp arm pad follows the clamp arm biased electrode with wearable stops. In one aspect, the clamp arm pad contains a feature for securing the electrode to the pad. As the pad height wears or is cut through, the electrode height with respect to the clamp arm is progressively adjusted. Once the clamp arm is moved away from the ultrasonic blade, the electrode stays in its new position.

Achieving sufficient clamp arm pad life on a combination ultrasonic/bipolar RF energy surgical device requires maintaining a sufficiently small yet non-zero clamp arm pad-to-electrode gap throughout the life of the instrument to provide desirable ultrasonic and bipolar RF tissue effects. The electrode is adapted and configured for use with a combination ultrasonic/bipolar RF energy surgical device and is deflectable under load, where the electrode is one pole of the bipolar RF circuit and the ultrasonic blade is the opposite pole of the bipolar RF circuit.

The existing (seed) electrode is a flat electrode, which is practically horizontal or parallel to the clamp arm in the free state (no load). The electrode is fixed to the clamp arm at the proximal end and is free to deflect at the distal end. Accordingly, throughout this disclosure the electrode may be referred to as a cantilever beam electrode or as a deflectable/cantilever electrode. When clamped on tissue, the tissue loads the electrode, causing it to deflect toward the clamp arm.

In one aspect, the electrode “follows” the pad as it wears. In this aspect, the electrode is biased toward the clamp arm in the free state (whether by being a formed/curved electrode, or by attaching/welding the electrode non-parallel to the clamp arm) using any suitable fastening technique such as welding, laser welding, brazing, soldering, pressing, among other fastening techniques. Wearable stop features (on the pad or elsewhere) keep the electrode away from the clamp arm, until said stop features are worn away during use. Once worn away, the electrode is able to approach the clamp arm. These features could be tooth or ratchet shaped, a vertical taper, or other.

In one aspect, the present disclosure provides a deflectable/cantilever electrode, wherein in a free state, the electrode is biased toward clamp arm and may attached at an angle and made of a preformed curve using any suitable fastening technique such as welding, laser welding, brazing, soldering, pressing, among other fastening techniques.

In one aspect, the present disclosure provides an end-effector with a deflectable/cantilever electrode comprising wearable stop features to prevent the electrode from reaching or contacting the clamp arm. As the stop features wear, the electrode moves toward the clamp arm until it reaches the next stop. In one aspect, the stop features wear simultaneously with the clamp arm pad to maintain the appropriate gap between the clamp arm pad and the electrode. The features may be entirely separate from the clamp arm pad. The features can be configured to withstand clamping loads, but wear away due to heat (melting/flowing) or abrasion. Possible examples include teeth on one or more clamp arm pads (PTFE, polyimide, or other) and tapered profile on one or more clamp arm pads (PTFE, polyimide, or other).

FIG. 62 illustrates an end-effector clamp arm 1710 comprising a clamp jaw 1712, an electrode 1714, and a clamp arm pad 1716, according to at least one aspect of the present disclosure. The clamp arm 1710 is configured for use with an end-effector comprising an ultrasonic blade (not shown) as described throughout this disclosure. The clamp arm 1710 also comprises a wear resistant gap pad 1717 to set a gap between the electrode 1714 and the ultrasonic blade. As shown, in the free state, the electrode 1714 is biased in a level or horizontal 1718 orientation. The electrode 1714 is fixed to the clamp jaw 1712 at the proximal end and is free to deflect at the distal end. Accordingly, throughout this disclosure the electrode 1714 may be referred to as a cantilever beam electrode or as a deflectable electrode.

FIG. 63 illustrates an end-effector clamp arm 1720 comprising a clamp jaw 1722, an electrode 1724, and a clamp arm pad 1726, according to at least one aspect of the present disclosure. The clamp arm 1720 is configured for use with an end-effector comprising an ultrasonic blade (not shown) as described throughout this disclosure. The clamp arm 1720 also comprises a wear resistant gap pad 1727 to set a gap between the electrode 1724 and the ultrasonic blade. As shown, in the free state, the electrode 1724 is configured pre-formed, bent, or is otherwise biased toward the clamp jaw 1722 along line 1728 away from the horizontal 1718 orientation. The electrode 1724 is fixed to the clamp arm 1720 at the proximal end and is free to deflect at the distal end. Accordingly, throughout this disclosure the electrode 1724 may be referred to as a cantilever beam electrode or as a deflectable electrode. To prevent the biased electrode 1724 from bending toward the clamp jaw 1722 under the biasing force, the clamp arm 1720 further comprises a retainer to prevent the biased electrode 1724 from bending toward the clamp jaw 1722 and maintaining the biased electrode 1724 in a substantially flat configuration (e.g., parallel, level, or horizontal) relative to the ultrasonic blade. Examples of retainers such as a retainer tooth 1738 and a retainer wall 1760 with a tapered profile are described below in FIGS. 64-67 .

FIG. 64 illustrates an end-effector clamp arm 1730 comprising a clamp jaw 1732, an electrode 1734, and a clamp arm pad 1736, according to at least one aspect of the present disclosure. The clamp arm 1730 is configured for use with an end-effector comprising an ultrasonic blade (not shown) as described throughout this disclosure. The clamp arm 1730 also comprises a wear resistant gap pad 1737 to set a gap between the electrode 1744 and the ultrasonic blade. In the free state, the electrode 1734 is configured pre-formed curved, bent, or otherwise biased toward the clamp jaw 1732. However, a retainer tooth 1738, or similar feature, is provided on the clamp arm pad 1736 to prevent the electrode 1734 from springing in toward the clamp jaw 1732. In FIG. 65 , when the bottom retainer tooth 1738 is worn away, the electrode 1734 can move toward the clamp jaw 1732 due to the pre-formed curve, according to at least one aspect of the present disclosure. The electrode 1734 is fixed to the clamp arm 1730 at the proximal end and is free to deflect at the distal end. Accordingly, throughout this disclosure the electrode 1734 may be referred to as a cantilever beam electrode or as a deflectable electrode.

FIG. 66 illustrates an end-effector clamp arm 1750 comprising a clamp jaw 1752, an electrode 1754, and a clamp arm pad 1756, according to at least one aspect of the present disclosure. The clamp arm 1750 is configured for use with an end-effector comprising an ultrasonic blade (not shown) as described throughout this disclosure. The clamp arm 1750 also comprises a wear resistant gap pad 1757 to set a gap between the electrode 1754 and the ultrasonic blade. In the free state, the electrode 1754 is configured pre-formed with a curve, bent, or otherwise biased toward 1758 the clamp jaw 1752. However, a retainer wall 1760 having a tapered profile, or similar feature, is provided on the clamp arm pad 1756 to prevent the electrode 1754 from springing in toward the clamp jaw 1752.

In FIG. 67 , when the tapered profile retainer wall 1760 is worn away, there is sufficient melting/flowing away from the tapered profile retainer wall 1760 region to allow the electrode 1754 to move toward the clamp jaw 1752 due to the pre-formed curve, according to at least one aspect of the present disclosure. The electrode 1754 is fixed to the clamp jaw 1752 at the proximal end and is free to deflect at the distal end. Accordingly, throughout this disclosure the electrode 1754 may be referred to as a cantilever beam electrode or as a deflectable electrode.

In one aspect, the present disclosure provides an end-effector for a combination ultrasonic/bipolar RF energy surgical device that employs a constant pressure distribution biasing mechanism. In one aspect, the end-effector includes an elastic compressible support for mounting and insulating a deflectable electrode. In one aspect, a hollow honeycomb or chambered elastomer support attachment cushion can be employed to allow all or part of the electrode attached to it to deflect but be biased towards the ultrasonic blade. This configuration could provide the added benefit of thermally insulating the electrode from the rest of the metallic clamp jaw. This would also provide an elastomer “curtain” around the electrode to minimize tissue accumulation behind the electrode. In one aspect, a non-strut deflectable geometry for the elastomer cells will enable the deflection force to be held constant over a predefined range of deflections. The electrode is adapted and configured for use with a combination ultrasonic/bipolar RF energy surgical device and is deflectable under load, where the electrode is one pole of the bipolar RF circuit and the ultrasonic blade is the opposite pole of the bipolar RF circuit.

The above configuration prevents lateral skew of the electrode under compression to prevent shorting. Further, the deflectable electrode is affixed to the elastomer and the elastomer is affixed to the metallic clamp arm. The solid height of the spring is limited from driving allowable compression while maintaining as much metallic clamp arm as possible. Thermal conduction from tissue interface is balanced and minimizes—impacts lesion formation and symmetry, cycle time, and residual thermal energy.

Configurations of end-effectors comprising a deflectable/cantilever electrode described hereinabove with respect to FIGS. 1-61 may be combined with a flexible electrode disposed above a lattice cushion and a plurality of hard spacers to set a gap between the flexible electrode and the ultrasonic blade as described hereinbelow with respect to FIGS. 68-70 .

Configurations of a biased electrode as described hereinabove with respect to FIGS. 62-67 may be combined with a flexible electrode disposed above a lattice cushion and a plurality of hard spacers to set a gap between the flexible electrode and the ultrasonic blade as described hereinbelow with respect to FIGS. 68-70 .

Configurations of end-effectors comprising a deflectable/cantilever electrode described hereinabove with respect to FIGS. 1-61 in combination with a biased electrode as described hereinabove with respect to FIGS. 62-67 may be combined with a flexible electrode disposed above a lattice cushion and a plurality of hard spacers to set a gap between the flexible electrode and the ultrasonic blade as described hereinbelow with respect to FIGS. 68-70 .

FIGS. 68-70 illustrate an end-effector 1810 comprising a clamp arm 1812, an ultrasonic blade 1814, a lattice cushion 1816, a flexible electrode 1818 disposed above the lattice cushion 1816, and a plurality of hard spacers 1820 to set a gap between the flexible electrode 1818 and the ultrasonic blade 1814, according to at least one aspect of the present disclosure. FIG. 70 is an exploded view of the end-effector 1810 shown in FIGS. 68-69 . A clamp arm pad 1822 is disposed inside a slot 1825 formed within the lattice cushion 1816. The lattice cushion 1816 acts as a spring-like element. The hard spacers 1820 are used to set a gap between the flexible electrode 1818 and the ultrasonic blade 1814.

In FIG. 68 the clamp arm 1812 is open and tissue 1824 of non-uniform thickness (T_(1a), T_(2a), T_(3a)) is disposed over the flexible electrode 1818. In FIG. 69 the clamp arm 1812 is closed to compress the tissue 1824. The lattice cushion 1816 on the clamp arm 1812 results in consistent tissue 1824 (T_(1b), T_(2b), T_(3b)) compression across variable thickness tissue 1824 (T_(1a), T_(2a), T_(3a)), such that:

$\frac{T_{1a}}{T_{1b}} = {\frac{T_{2a}}{T_{2b}} = \frac{T_{3a}}{T_{3b}}}$

Additional background disclosure may be found in EP3378427, WO2019/006068, which are herein incorporated by reference in their entirety.

In one aspect, the present disclosure provides an end-effector for a combination ultrasonic/bipolar RF energy surgical device with means for insuring distal tip contact with bias using a zero gap bipolar RF energy system. In various aspects, the present disclosure provides a deflectable electrode for a combination ultrasonic/bipolar RF energy surgical device with a higher distal bias than proximal bias. In one aspect, the present disclosure provides a combination energy device comprising a bipolar electrode that is deflectable with respect to the clamp arm. The combination energy device comprises features to change the mechanical properties of the tissue compression proximal to distal to create a more uniform or differing pattern of pressure than due to the clamping forces alone. In one aspect, the present disclosure provides a non-linear distal distributing mechanism and in another aspect the present disclosure provides electrical non-linear distribution of energy density. The electrode is adapted and configured for use with a combination ultrasonic/bipolar RF energy surgical device and is deflectable under load, where the electrode is one pole of the bipolar RF circuit and the ultrasonic blade is the opposite pole of the bipolar RF circuit.

Configurations of end-effectors comprising a deflectable/cantilever electrode described hereinabove with respect to FIGS. 1-61 may be combined with a conductive polymer clamp arm pad as described hereinbelow with respect to FIGS. 71-85 .

Configurations of a biased electrode as described hereinabove with respect to FIGS. 62-67 may be combined with a conductive polymer clamp arm pad as described hereinbelow with respect to FIGS. 71-85 .

Configurations of a flexible electrode disposed above a lattice cushion and a plurality of hard spacers to set a gap between the flexible electrode and the ultrasonic blade as described hereinabove with respect to FIGS. 68-70 may be combined with a conductive polymer clamp arm pad as described hereinbelow with respect to FIGS. 71-85 .

Configurations of a biased electrode as described hereinabove with respect to FIGS. 62-67 may be combined with a flexible electrode disposed above a lattice cushion and a plurality of hard spacers to set a gap between the flexible electrode and the ultrasonic blade as described hereinabove with respect to FIGS. 68-70 may be combined with a conductive polymer clamp arm pad as described hereinbelow with respect to FIGS. 71-85 .

Configurations of a biased electrode as described hereinabove with respect to FIGS. 62-67 may be combined with a flexible electrode disposed above a lattice cushion and a plurality of hard spacers to set a gap between the flexible electrode and the ultrasonic blade as described hereinabove with respect to FIGS. 68-70 may be combined with a conductive polymer clamp arm pad as described hereinbelow with respect to FIGS. 71-85 .

Configurations of end-effectors comprising a deflectable/cantilever electrode described hereinabove with respect to FIGS. 1-61 in combination with a biased electrode as described hereinabove with respect to FIGS. 62-67 may be combined with a conductive polymer clamp arm pad as described hereinbelow with respect to FIGS. 71-85 .

Configurations of end-effectors comprising a deflectable/cantilever electrode described hereinabove with respect to FIGS. 1-61 in combination with a biased electrode as described hereinabove with respect to FIGS. 62-67 may be combined with a flexible electrode disposed above a lattice cushion and a plurality of hard spacers to set a gap between the flexible electrode and the ultrasonic blade as described hereinabove with respect to FIGS. 68-70 may be combined with a conductive polymer clamp arm pad as described hereinbelow with respect to FIGS. 71-85 .

In various aspects, the present disclosure provides a combination ultrasonic/bipolar RF energy surgical device comprising an ultrasonic pad with partially or fully electrically conductive portions such that the pad behaves as both the blade support/wear pad and the bipolar RF electrode. In one aspect, the present disclosure provides a partially conductive clamp arm pad to enable electrode wear and minimize short circuiting in a combination bipolar RF and ultrasonic energy device where the clamp arm pad has conductive and non-conductive portions allowing it to act as one of the RF electrodes while also acting as a wearable support structure for the ultrasonic blade. In another aspect, the present disclosure provides conductive portions around the perimeter of the clamp arm pad and not positioned directly on the side that is opposite the ultrasonic blade contact area. In another aspect, a portion of the conductive clamp arm pad is degradable or wearable preventing contact from the ultrasonic blade from interrupting the conductivity of the remaining portions of the conductive clamp arm pad.

In one aspect, the present disclosure provides an end-effector for a combination ultrasonic/bipolar RF energy surgical device comprising a conductive polymer ultrasonic clamp arm pad. In one aspect, the end-effector comprises a clamp arm pad doped with tin oxide. FIG. 71 is a section view of a conductive polymer clamp arm pad 2440, according to at least one aspect of the present disclosure. The conductive polymer clamp arm pad 2440 comprises tin oxide 2442 (SnO₂) embedded in a polymer material 2444, such as Teflon (PTFE), to make the clamp arm pad 2440 electrically conductive. The doping may be achieved using a cold spray process. Once doped, the conductive polymer clamp arm pad 2440 can achieve traditional ultrasonic tissue clamp arm pad functions such as, for example, contacting the ultrasonic blade, absorbing heat from the ultrasonic blade, and assisting in tissue grasping and clamping. The tin oxide doped clamp arm pad 2440 functions as one of the two electrodes or poles of the bipolar RF circuit to deliver RF energy to tissue grasped between the ultrasonic blade and the clamp arm pad 2440. The tin oxide doped clamp arm pad 2440 is biocompatible, electrically conductive, thermally conductive, enables a large portion of the clamp arm pad 2440 to be used to improve wear resistance of the clamp arm pad 2440, and is white in color. The electrode is adapted and configured for use with a combination ultrasonic/bipolar RF energy surgical device and is deflectable under load, where the electrode is one pole of the bipolar RF circuit and the ultrasonic blade is the opposite pole of the bipolar RF circuit.

In one aspect, the present disclosure provides a conductive polymer ultrasonic clamp arm pad as an electrode replacement. To improve the life of the ultrasonic clamp arm pad and improve the RF tissue effects, the present disclosure provides an electrode that is improved, easier to make, and less costly to make. In one aspect, the present disclosure provides a clamp arm pad comprising hard polyimide polymer layers and electrically conductive layers to allow the clamp arm pad to achieve traditional functions as well as carry bipolar electricity to eliminate the need for a separate electrode in the clamp arm of a combined energy end-effector. In this manner, the clamp jaw can be me manufactured in a manner similar to the ultrasonic-only clamp jaw with the new clamp arm pad material swapped for the traditional ultrasonic-only clamp arm pad. The electrode is adapted and configured for use with a combination ultrasonic/bipolar RF energy surgical device and is deflectable under load, where the electrode is one pole of the bipolar RF circuit and the ultrasonic blade is the opposite pole of the bipolar RF circuit.

Benefits include improved ultrasonic performance, including clamp arm pad wear, similar to current ultrasonic-only instruments because there are no electrode gaps between elements “squares” of polymer. The cost of the improved clamp jaw will be similar to current ultrasonic-only clamp jaws because of the need for a separate electrode component is eliminated and provides multiple small polymer square elements. In addition, the manufacturing steps needed to make the clamp jaw are the same as the manufacturing steps required for making current ultrasonic-only clamp jaws. Manufacturing the improved clamp jaw requires only the substitution of the clamp arm pad and does require the production of an additional electrode component to add to the clamp jaw and eliminates assembly steps.

FIG. 72 is a perspective view of a clamp arm pad 2450 configured to replace a conventional electrode, according to at least one aspect of the present disclosure. The clamp arm pad 2450 comprises electrically non-conductive layers 2452 and electrically conductive layers 2454 in a sandwich-like configuration. This configuration eliminates the need for a spring loaded electrode plate. The electrically non-conductive layers 2452 can be made of polymer, polyimide, Teflon (PTFE) and similar electrically non-conductive materials. The conductive layers 2454 may be made of thin electrically conductive polymer, metal foil, or carbon loaded material. The clamp arm pad 2450 may be manufactured such that the majority of the material contacting the ultrasonic blade are the electrically non-conductive layers 2452. In one aspect, 75% of the material contacting the ultrasonic blade is electrically non-conductive material such as PTFE. In another aspect, 85% of the material contacting the ultrasonic blade is electrically non-conductive material such as PTFE. In another aspect, 95% of the material contacting the ultrasonic blade is electrically non-conductive material such as PTFE. Additionally, as the clamp arm pad 2450 wears, the electrically conductive layers 2452 will still have available surface area to conduct RF electricity through the tissue and return electrode (e.g., ultrasonic blade).

FIG. 73 illustrates a clamp arm 2460 comprising the clamp arm pad 2450 described in FIG. 72 , according to at least one aspect of the present disclosure. In the illustrated clamp arm 2460, the non-conductive layers 2452 have a large surface area compared to the conductive layers 2454, which appear as thin layers or foils.

FIG. 74 illustrates clamp arm pads configured as described in FIGS. 23-24 , according to at least one aspect of the present disclosure. The first clamp arm pad 2470 is new and comprises teeth 2472 formed integrally therewith. The second clamp arm pad 2476 is new and without teeth. The third clamp arm pad 2478 worn and may be representative of either the first clamp arm pad 2470 or the second clamp arm pad 2476.

In one aspect, the present disclosure provides a composite clamp arm pad for a combination ultrasonic/bipolar RF energy surgical device. FIG. 75 is a section view of a clamp arm 2480 comprising a composite clamp arm pad 2482 in contact with tissue 2484, according to at least one aspect of the present disclosure. The end-effector 2480 comprises an upper clamp jaw 2486 and an adhesive 2488 to fixedly attach the composite clamp arm pad 2482 to the upper clamp jaw 2486. The composite clamp arm pad 2482 comprises thin electrically non-conductive layers 2490 (e.g., PTFE) and thin electrically conductive layers 2492 (e.g., thin stainless steel foils). The electrically conductive layers 2492 form the electrode portion of the composite clamp arm pad 2482. The electrically conductive layers 2492 (e.g., thin stainless steel foils) deform as the electrically non-conductive layers 2490 (e.g., PTFE) wear-away. The thickness of the electrically conductive layers 2492 enables the electrode portion of the composite clamp arm pad 2482 to deform as the electrically non-conductive layers 2490 wear-away. Advantageously, the electrically conductive layers 2492 conduct some of the heat away from the electrically non-conductive layers 2490 to keep the composite clamp arm pad 2482 cooler. As described above, the composite clamp arm pad 2482 is fixed to the upper clamp jaw 2486 by an adhesive 2488. The adhesive 2488 may be filled with carbon to make it electrically conductive and connect the electrode portions of the composite clamp arm pad 2482 to the upper clamp jaw 2486. The electrode is adapted and configured for use with a combination ultrasonic/bipolar RF energy surgical device and is deflectable under load, where the electrode is one pole of the bipolar RF circuit and the ultrasonic blade is the opposite pole of the bipolar RF circuit.

In one aspect, the clamp arm pad comprises cooperative conductive and insulative portions. In one aspect, the present disclosure provides a combination ultrasonic/bipolar RF energy surgical device where the clamp arm pad has conductive and non-conductive portions allowing it to act as one of the RF electrodes while also acting as the wearable support structure for the ultrasonic blade. In another aspect, the conductive portions of the clamp arm pad are disposed around the perimeter of the pad and are not positioned directly on the side that is opposite the ultrasonic blade contact area. In another aspect, the conductive portion of the clamp arm pad is degradable or wearable to prevent contact with the ultrasonic blade from interrupting the conductivity of the remaining conductive portions of the clamp arm pad.

In one aspect, the present disclosure provides a clamp arm pad for use with combination ultrasonic/bipolar RF energy devices where portions of the clamp arm pad include electrically conductive material and other portions include electrically non-conductive material. The electrode is adapted and configured for use with a combination ultrasonic/RF energy device and is deflectable under load, where the electrode is one pole of the bipolar RF circuit and the ultrasonic blade is the opposite pole of the bipolar RF circuit.

In various aspects, the clamp arm pad may be manufactured using a variety of techniques. One technique comprises a two shot process of molding conductive and non-conductive materials in the same compression mold. This process effectively creates a single clamp arm pad with portions that can act as a bipolar RF electrode and others that will act as electrical insulators. Another technique comprises a super sonic cold spray embedding of metallic elements into a polymeric (e.g., Teflon, PTFE) pad or matrix. Another technique comprises 3D printing of multiple materials (e.g., Teflon, PTFE, and doped conductive polymer), printing/transfer printing conductive or functional inks onto clamp arm pad. Another technique comprises metals and conductive materials (e.g., graphite/carbon) may be applied to the clamp arm pad using chemical vapor deposition, physical vapor deposition, sputter deposition, vacuum deposition, vacuum metalizing, or thermal spray. Another technique comprises conductive/loaded clamp arm pad electrodes provide continuity through the pad with micro randomly oriented and positioned particles or macro oriented structures (e.g., fabric, woven, long constrained fibers. Another technique comprises making the surface of the clamp arm pad conductive, providing wear-through electrodes, 3D printing, thermal spraying, cold spraying, coatings/paints/epoxies, sheet/foil/wire/film wrapping or laminating, vacuum metalizing, printing/transferring, among other techniques. In another technique, polymer electrodes filled with conductive material.

In one aspect, the end-effector clamp arm comprises a fixed polymer electrode. FIG. 76 illustrates a clamp arm 2500 comprising a clamp jaw 2502 to support a carrier 2504 or stamping attached to the clamp jaw 2502 and a clamp arm pad 2506, according to at least one aspect of the present disclosure. The clamp arm pad 2506 comprises an electrically conductive pad 2508 and an electrically non-conductive pad 2510. The electrically conductive pad 2508 is made of an electrically conductive polymer and acts as one of the electrodes of the bipolar RF circuit. The clamp jaw 2502 and the carrier 2504 may be made of stainless steel and attached using any suitable fastening technique such as welding, laser welding, brazing, soldering, pressing, among other fastening techniques, for example. The electrically conductive pad 2508 may comprise a polymer such as, for example, silicone, fluorosilicone, PTFE, and similar materials. The electrically conductive pad 2508 is overmolded onto the carrier 2504 using PTFE, silicone, fluorosilicone filled with silver particles, silver over aluminum, silver over copper, copper, nickel, graphite, carbon (amorphous, chopped fiber), gold, platinum, stainless steel, iron, or zinc, or combinations thereof.

FIG. 77 is a section view taken at section 77-77 in FIG. 76 and FIG. 78 is a section view taken at section 78-78 in FIG. 76 . The sections views 77-77 and 78-78 show the clamp arm 2500 comprising the clamp jaw 2502, the support carrier 2504, the electrically conductive pad 2508, and the electrically non-conductive pad 2510.

FIG. 79 is a section view of an alternative implementation of a clamp arm 2520 comprising a clamp jaw 2522, an electrically conductive pad 2524, and an electrically non-conductive pad 2526, according to at least one aspect of the present disclosure. The electrically conductive pad 2524 is made of an electrically conductive polymer and acts as one of the electrodes in the bipolar RF circuit.

FIG. 80 is a section view of an alternative implementation of a clamp arm 2530 comprising a clamp jaw 2532, a carrier 2534 or stamping welded to the clamp jaw 2532, an electrically conductive pad 2536, and an electrically non-conductive pad 2538, according to at least one aspect of the present disclosure. The electrically conductive pad 2536 is made of an electrically conductive polymer and acts as one of the electrodes in the bipolar RF circuit. The electrically conductive pad 2536 is overmolded over the carrier 2534 or stamping.

In one aspect, the end-effector clamp arm comprises a film over metal insert molded electrode assembly. In one aspect, a film may be provided over a metal (e.g., stainless steel) insert molded electrode assembly. A film over metal such as stainless steel can be insert molded to form an electrode assembly. The film on the insert molded electrode may be etched to form micro-holes, slots, honeycomb, among other patterns, to enable conduction of RF energy as well as to cut the periphery of the component. The film may be formed onto or bond onto a stainless steel electrode using IML/FIM (In-Mold Labeling/Film Insert Molding) processes described hereinbelow. The charged film electrode may be placed into a polymer injection mold tool to mold a polymer to the back of the electrode and film. The electrode is adapted and configured for use with a combination ultrasonic/bipolar RF energy surgical device and is deflectable under load, where the electrode is one pole of the bipolar RF circuit and the ultrasonic blade is the opposite pole of the bipolar RF circuit.

FIG. 81 illustrates insert molded electrodes 2540, according to at least one aspect of the present disclosure. The insert molded electrode 2540 comprises an electrically conductive element 2546, a molded polymer pad 2548, and a film 2542 coating. Features 2550 such as micro-holes, slots, honeycomb, or similar features, are formed in the film 2542 to allow the passage of RF energy. Retention features 2552 also are formed on the film 2542. The side walls 2558 of the film 2542 extend below the bottom of the polymer pad 2548 may be folded around the bottom of the polymer pad 2548 and over molded with retention posts. The retention features 2552 are molded into the holes 2554 defined by the film 2542. Although the two insert molded electrodes 2540 are shown with a gap between them, in actuality, the two insert molded electrodes 2540 are fit line-to-line 2556 via mold pressure.

The conductive element 2546 may be made of an electrically conductive metal such as stainless steel or similar conductive material. The conductive element 2546 can be about 0.010″ thick and may be selected within a range of thicknesses of 0.005″ to 0.015″ and can be formed by tamping or machining. The film 2544 can be about 0.001″ to 0.002″ thick and may be made of polyimide, polyester, or similar materials. Alternatively to mechanical retention, such as posts, the film 2544 can be directly bonded to the conductive element 2546. One example includes DuPont Pyralux HXC Kapton film with epoxy adhesive backing having a thickness of 0.002″.

Advantageously, the non-stick surface prevents tissue from sticking to the insert molded electrode 2540. The non-stick surface eliminates short circuiting of opposing electrodes by setting a gap within the range of 0.002″ to 0.004″ along the entire length of the insert molded electrode 2540. The non-stick surface minimizes lateral spread of RF energy due to coverage of side walls 2558 of the insert molded electrode 2540. Also, the insert molded electrode 2540 exhibits structural soundness and provides an easier more robust electrical connection than a multi-layer flexible circuit.

In one aspect, the end-effector comprises a conductive clamp arm and pad constructs for combination ultrasonic/bipolar RF energy surgical devices. In one aspect, the present disclosure provides a clamp arm assembly comprising a conductive or selectively conductive thin film, foil, or laminate that is applied to, around or on the clamp arm assembly to serve as a durable “pole” in a combination ultrasonic/bipolar RF energy surgical device. Further, an algorithm, software, or logic is provided to manage conditions of electrical short circuiting. The electrode is adapted and configured for use with a combination ultrasonic/bipolar RF energy surgical device and is deflectable under load, where the electrode is one pole of the bipolar RF circuit and the ultrasonic blade is the opposite pole of the bipolar RF circuit.

FIG. 82 illustrates an end-effector 2560 comprising an ultrasonic blade 2562, a clamp arm 2564, and a clamp arm pad 2566 comprising an electrically conductive film 2568, according to at least one aspect of the present disclosure.

FIG. 83 illustrates the clamp arm 2564 shown in FIG. 82 . The clamp arm 2564 comprising a clamp jaw 2570 to support the clamp arm pad 2566. A thin electrically conductive film 2568 is disposed over the clamp arm pad 2566 to form an electrode of one of the poles of the bipolar RF circuit.

FIG. 84 is a section view of the clamp arm 2564 taken along section 84-84 in FIG. 83 . The clamp jaw 2570 can be made of metal such as stainless steel. The clamp arm pad 2566 can be made of an electrically non-conductive complaint material such as PTFE, silicone, high temperature polymer, or similar materials. The electrically conductive film 2568 or foil can be made of an electrically conductive material such as titanium, silver, gold, aluminum, zinc, and any alloys thereof including stainless steel.

FIG. 85 illustrates a clamp arm 2580 comprising a partially electrically conductive clamp arm pad 2582, according to at least one aspect of the resent disclosure. An electrically conductive foil 2584 covers a portion of an electrically non-conductive pad 2586. The electrically non-conductive pad 2588 at the proximal end 2590 sets a gap between the clamp arm pad 2582 and the ultrasonic blade.

Elements of the electrically conductive film 2568, foil, or laminate may include, for example, a single layer of thin conductive material such as metals (titanium, silver, gold, zinc, aluminum, magnesium, iron, etc. and their alloys or stainless steels), plated metals (nickel and then gold over copper, for example) or polymers filled heavily with conductive materials such as metal powder, or filings. Preferably, it is a biocompatible metal foil such as titanium, silver, gold, zinc, or stainless steel selected from a thickness within the range of 0.001″ to 0.008″ (0.025 mm-0.20 mm).

The film 2568, foil, or laminate may include a thin polymer coating, film or layer covering the thin conductive material described above. This coating, film or layer is highly resistive, that is, it is not an effective conductor of bipolar RF energy to adjacent tissue. The coating may be perforated to allow for energy delivery from the electrode to tissue.

The conductive material may be perforated or contain holes or windows through the full thickness of the conductive material to minimize the thermal capacitance of this layer (testing has shown that long and/or thick foils result in longer transection times due to thermal energy being removed from the treatment sight. These perforations, holes or windows also may allow for retention of the foil to other parts or layers. These perforations, holes or windows may be patterned across the entire foil sheet or may be localized at the treatment site or away from the treatment site such as, for example, on the sides of the clamp arm only.

If present, the thin polymer coating, film or layer may be perforated or contain full thickness holes or windows such that the conductive film, foil or laminate is in direct communication with tissue for delivery of bipolar radiofrequency energy to the tissue. For coatings, these holes or windows may be formed by selective coating or coating removal.

Ideally, the conductive film 2568, foil, or laminate is in direct contact with the clamp arm structure that is typically fabricated from stainless steel. The resulting conductive path then allows for simplicity of construction in that the path is formed by necessary structural component, namely a support tube or actuator that connects directly to the clamp arm and then the conductive film, foil or laminate.

In one aspect, the conductive film 2568, foil, or laminate is backed by a relatively soft, high temperature, low wear polymer or elastomer pad made from materials such as PTFE, silicone, polyimide, high temperature thermoplastics, among other materials. The compliance of this relatively soft pad allows for a wide range of component tolerances to obtain a zero or near zero gap between the jaw and the ultrasonic blade along its full tissue effecting length when the jaw is fully closed, thus allowing tissue to be sealed and cut along this length. The compliance also eliminates or greatly dampens any audible vibration of the conductive layer that may occur when the ultrasonic blade is closed against the conductive layer.

The conductive film 2568, foil, or laminate may include a rigid to semi-rigid polymer on its backside/back surface (that is the surface away from the tissue and toward the clamp arm). This part is made from injection moldable polymers or polymer alloys and adhered to the film, foil or laminate by way of Film Insert Molding (FIM) or In-Mold Labeling (IML).

In testing, thin stainless steel, copper, or aluminum foils are quiet in operation (no “screeching” or emitting of obtuse squeals). The thin stainless steel, copper, or aluminum foils provide a robust surface against which the ultrasonic blade can act. Robust enough that materials such as silicone rubber that would otherwise tear and serve as a poor pad material are usable and do not easily tear or split.

The proximal portion of the jaw clamping surface may not include the conductive film, foil or laminate because this area of the jaw contacts the blade first and will be more likely result in shunting of power/shorting in this area.

In one aspect, the present disclosure provides a short circuit mitigation algorithm for activating an output including bipolar RF energy.

A short alert is not given to the user if it occurs after the energy delivered for the activation exceeds a threshold amount (thereby indicating that the tissue thinned but has likely received an adequate dose of bipolar RF energy for the sealing, coagulation of tissue), or an activation time threshold has been exceeded (again, thereby indicating that the tissue has thinned but has likely received and adequate dose), or both energy and activation time thresholds have been exceeded.

A process of making a film over stainless steel insert molded electrode assembly comprises etching the film and forming apertures (micro-holes, slots, or honeycomb) for passing RF energy; cutting periphery of the electrode component; forming a film onto/bond onto stainless steel electrode if needed; placing the charged film and electrode into a polymer injection mold tool; molding the polymer to the back of the electrode and film.

In various aspects, the present disclosure provides combination ultrasonic/bipolar RF energy surgical devices and systems. Various forms are directed to user interfaces for surgical instruments with ultrasonic and/or electrosurgical (RF) end-effectors configured for effecting tissue treating, dissecting, cutting, and/or coagulation during surgical procedures. In one form, a user interface is provided for a combined ultrasonic and electrosurgical instrument that may be configured for use in open surgical procedures, but has applications in other types of surgery, such as minimally invasive laparoscopic procedures, for example, non-invasive endoscopic procedures, either in hand held or and robotic-assisted procedures. Versatility is achieved by selective application of multiple energy modalities simultaneously, independently, sequentially, or combinations thereof. For example, versatility may be achieved by selective use of ultrasonic and electrosurgical energy (e.g., monopolar or bipolar RF energy) either simultaneously, independently, sequentially, or combinations thereof.

In one aspect, the present disclosure provides a user interface for an apparatus comprising an ultrasonic blade and clamp arm with a deflectable RF electrode such that the ultrasonic blade and deflectable RF electrode cooperate to effect sealing, cutting, and clamping of tissue by cooperation of a clamping mechanism of the apparatus comprising the RF electrode with an associated ultrasonic blade. The clamping mechanism includes a pivotal clamp arm which cooperates with the ultrasonic blade for gripping tissue therebetween. The clamp arm is preferably provided with a clamp tissue pad (also known as “clamp arm pad”) having a plurality of axially spaced gripping teeth, segments, elements, or individual units which cooperate with the ultrasonic blade of the end-effector to achieve the desired sealing and cutting effects on tissue, while facilitating grasping and gripping of tissue during surgical procedures.

In one aspect, the end-effectors described herein comprise an electrode. In other aspects, the end-effectors described herein comprise alternatives to the electrode to provide a compliant coupling of RF energy to tissue, accommodate pad wear/thinning, minimize generation of excess heat (low coefficient of friction, pressure), minimize generation of sparks, minimize interruptions due to electrical shorting, or combinations thereof. The electrode is fixed to the clamp jaw at the proximal end and is free to deflect at the distal end. Accordingly, throughout this disclosure the electrode may be referred to as a cantilever beam electrode or as a deflectable electrode.

In other aspects, the end-effectors described herein comprise a clamp arm mechanism configured to high pressure between a pad and an ultrasonic blade to grasp and seal tissue, maximize probability that the clamp arm electrode contacts tissue in limiting or difficult scenarios, such as, for example, thin tissue, tissue under lateral tension, tissue tenting/vertical tension especially tenting tissue away from clamp arm.

In other aspects, the end-effectors described herein are configured to balance match of surface area/current densities between electrodes, balance and minimize thermal conduction from tissue interface, such as, for example, impacts lesion formation and symmetry, cycle time, residual thermal energy. In other aspects, the end-effectors described herein are configured to minimize sticking, tissue adherence (minimize anchor points) and may comprise small polyimide pads.

In various aspects, the present disclosure provides a surgical device configured to deliver at least two energy types (e.g., ultrasonic, monopolar RF, bipolar RF, microwave, or irreversible electroporation [IRE]) to tissue. The surgical device includes a first activation button switch for activating energy, a second button switch for selecting an energy mode for the activation button switch. The second button switch is connected to a circuit that uses at least one input parameter to define the energy mode. The input parameter can be modified remotely through connection to a generator or through a software update.

In one aspect, at least one of the energy modes is a simultaneous blend of RF and ultrasonic energy, and the input parameter represents a duty cycle of the RF and ultrasonic energy.

In one aspect, the second button switch is configurable to select from a list of predefined modes and the number of modes in the list is defined by a second input parameter defined by a user.

In one aspect, the input parameter is either duty cycle, voltage, frequency, pulse width, or current.

In one aspect, the device also includes a visual indicator of the selected energy mode within the portion of device in the surgical field

In one aspect, the second button switch is a separate control from the end effector closure trigger.

In one aspect, the second button switch is configured to be activated second stage of the closure trigger. The first stage of the closure trigger in the closing direction is to actuate the end effector.

In one aspect, at least one of the energy modes is selected from ultrasonic, RF bipolar, RF monopolar, microwave, or IRE.

In one aspect, at least one of the energy modes is selected from ultrasonic, RF bipolar, RF monopolar, microwave, or IRE and is configured to be applied in a predefined duty cycle or pulsed algorithm.

In one aspect, at least one of the energy modes is selected from a sequential application of two or more of the following types of energy: ultrasonic, RF bipolar, RF monopolar, microwave, or IRE.

In one aspect, at least one of the energy modes is a simultaneous blend of two or more of the following types of energy: ultrasonic, RF bipolar, RF monopolar, microwave, and IRE.

In one aspect, at least one of the energy modes is a simultaneous blend of two or more of the following types of energy: ultrasonic, RF bipolar, RF monopolar, microwave, and IRE followed sequentially by one or more of the aforementioned energies.

In one aspect, at least one of the energy modes is one off the following types of energy: Ultrasonic, RF bipolar, RF monopolar, microwave, and IRE followed sequentially by a simultaneous blend of two or more of the aforementioned energies.

In one aspect, at least one of the energy modes is procedure or tissue specific predefined algorithm.

In one aspect, at least one of the energy modes is compiled from learned surgical behaviors or activities.

In one aspect, the input parameter is at least one of: energy type, duty cycle, voltage, frequency, pulse width, current, impedance limit, activation time, or blend of energy.

In one aspect, the second button switch is configurable to select from a list of predefined modes and the number of modes in the list is either predefined or defined by a second input parameter defined by a user.

In one aspect, the aforementioned energy modes are made available to the user through software updates to the generator.

In one aspect, the aforementioned energy modes are made available to the user through software updates to the device.

In one aspect, the preferred selections by the user are made available to multiple generators through either networking, the cloud, or manual transfer.

In one aspect, the device also includes a visual indicator of the selected energy mode within the portion of device in the surgical field.

As used herein a button switch can be a manually, mechanically, or electrically operated electromechanical device with one or more sets of electrical contacts, which are connected to external circuits. Each set of electrical contacts can be in one of two states: either “closed” meaning the contacts are touching and electricity can flow between them, or “open”, meaning the contacts are separated and the switch is electrically non-conducting. The mechanism actuating the transition between these two states (open or closed) can be either an “alternate action” (flip the switch for continuous “on” or “off”) or “momentary” (push for “on” and release for “off”) type.

In one aspect, the present disclosure provides a combination ultrasonic/bipolar RF energy surgical device comprising on device mode selection and visual feedback. As surgical devices evolve and become more capable, the number of specialized modes in which they can be operated increases. Adding extra button switches on a device to accommodate these new additional modes would complicate the user interface and make the device more difficult to use. Accordingly, the present disclosure provides techniques for assigning different modes to a single physical button switch, which enables a wider selection of modes without adding complexity to the housing design (e.g., adding more and more button switches). In one aspect, the housing is in the form of a handle or pistol grip.

As more specialized modes become available, there is a need to provide multiple modes to a surgeon using the surgical device without creating a complex user interface. Surgeons want to be able to control the mode selection from the sterile field rather than relying on a circulating nurse at the generator. Surgeon want real time feedback so they are confident they know which mode is selected.

FIG. 86 illustrates a surgical device 100 comprising a mode selection button switch 130 on the device 100, according to at least one aspect of the present disclosure. The surgical device 100 comprises a housing 102 defining a handle 104 in the form of a pistol grip. The housing 102 comprises a trigger 106 which when squeezed is received into the internal space defined by the handle 104. The trigger 106 is used to operate a clamp arm 111 portion of an end-effector 110. A clamp jaw 112 is pivotally movable about pivot point 114. The housing 102 is coupled to the end-effector 110 through a shaft 108, which is rotatable by a knob 122.

The end-effector 110 comprises a clamp arm 111 and an ultrasonic blade 116. The clamp arm 111 comprises a clamp jaw 112, an electrode 118, and a clamp arm pad 120. In one aspect, the clamp arm pad 120 is made of a non-stick lubricious material such as PTFE or similar synthetic fluoropolymers of tetrafluoroethylene. PTFE is a hydrophobic, non-wetting, high density and resistant to high temperatures, and versatile material and non-stick properties. The clamp arm pad 120 is electrically non-conductive. In contrast, the electrode 118 is made of an electrically conductive material to deliver electrical energy such as monopolar RF, bipolar RF, microwave, or irreversible electroporation (IRE), for example. The electrode 118 may comprises gap setting pads made of a polyimide material, and in one aspect, is made of a durable high-performance polyimide-based plastic known under the tradename VESPEL and manufactured by DuPont or other suitable polyimide, polyimide polymer alloy, or PET (Polyethylene Terephthalate), PEEK (Polyether Ether Ketone), PEKK (Poly Ether Ketone Ketone) polymer alloy, for example. Unless otherwise noted hereinbelow, the clamp arm pads and gap pads described hereinbelow are made of the materials described in this paragraph.

The electrode 118 and the ultrasonic blade 116 are coupled to the generator 133. The generator 133 is configured to drive RF, microwave, or IRE energy to the electrode 118. The generator 133 also is configured to drive an ultrasonic transducer acoustically coupled to the ultrasonic blade 116. In certain implementations, the electrode 118 is one pole of an electrical circuit and the ultrasonic blade 116 is the opposite pole of the electrical circuit. The housing 102 includes a switch 124 to activate the ultrasonic blade 116. The circuit may be contained in the housing 102 or may reside in the generator 133. The surgical device 100 is coupled to the generator 133 via a cable 131. The cable 131 conducts signals for the electrosurgical functions and the ultrasonic transducer.

In various aspects, the surgical device 100 is configured to deliver at least two energy types (e.g., ultrasonic, monopolar RF, bipolar RF, microwave, or irreversible electroporation [IRE]) to tissue located in the end-effector 110 between the clamp arm 111 and the ultrasonic blade 116. The housing 102 of the surgical device 100 includes a first activation button switch 126 for activating energy and a second “mode” button switch 130 for selecting an energy mode for the activation button switch. The second button switch 130 is connected to a circuit that uses at least one input parameter to define the energy mode. The input parameter can be modified remotely through connection to a generator or through a software update. The energy mode is displayed on a user interface 128.

In one aspect, the surgical instrument 100 provides mode switching through the on device directional selector “mode” button switch 130. The user can press the mode button switch 130 to toggle through different modes and the colored light on the user interface 128 indicates the selected mode.

According to various aspects of the present disclosure, different modes of operation can be assigned to the surgical device by pressing the “mode” button switch 130, where each time the mode button switch 130 is pressed, or pushed and held, the surgical device 100 toggles through the available modes, which are displayed on the user interface 128. Once a mode is selected, the generator 133 will provide the appropriate generator tone and the surgical device 100 will have a lighted indicator on the user interface 128 to indicate which mode was selected.

In the example illustrated in FIG. 86 , the “mode” selection button switch 130 is placed symmetrically on both sides of the housing 102. This enables both a right and left handed surgeon to select/toggle through modes without using a second hand. In this aspect, the “mode” selection button switch 130 can toggle in many different directions, which enables the surgeon to select from a list of options and navigate more complex selections remotely from the sterile field without having to ask a circulator to make adjustments at the generator 133. The lighted indicator on the user interface 128 of the surgical device 100, in addition to generator 133 tones, gives the surgeon feedback on which mode is selected.

FIGS. 87A-87C illustrate three options for selecting the various operating modes of the surgical device 100, according to at least one aspect of the present disclosure. In addition to the colored light user interface 128 on the housing 102 of the surgical device 100, feedback for mode selection is audible and/or visible through the generator 133 interface where the generator 133 announces the selected mode verbally and/or shows a description of the selected mode on a screen of the generator 133.

FIG. 87A shows a first mode selection option 132A where the button switch 130 can be pressed forward 136 or backward 134 to cycle the surgical instrument 100 through the various modes.

FIG. 87B shows a second mode selection option 132B where the button switch 130 is pressed up 140 or down 138 to cycle the surgical instrument 100 through the various modes.

FIG. 87C shows a third mode selection option 132C where the button switch 130 is pressed forward 136, backward 134, up 149, or down 138 to cycle the surgical instrument 100 through the various modes.

FIG. 88 illustrates a surgical device 150 comprising a mode selection button switch 180 on the back of the device 150, according to at least one aspect of the present disclosure. The surgical device 150 comprises a housing 152 defining a handle 154 in the form of a pistol grip. The housing 152 comprises a trigger 156 which when squeezed is received into the internal space defined by the handle 154. The trigger 156 is used to operate a clamp arm 161 portion of an end-effector 160. A clamp jaw 162 is pivotally movable about pivot point 164. The housing 152 is coupled to the end-effector 160 through a shaft 158, which is rotatable by a knob 172.

The end-effector 160 comprises a clamp arm 161 and an ultrasonic blade 166. The clamp arm 161 comprises a clamp jaw 162, an electrode 168, and a clamp arm pad 170. In one aspect, the clamp arm pad 170 is made of a non-stick lubricious material such as PTFE or similar synthetic fluoropolymers of tetrafluoroethylene. PTFE is a hydrophobic, non-wetting, high density and resistant to high temperatures, and versatile material and non-stick properties. The clamp arm pad 170 is electrically non-conductive. In contrast, the electrode 168 is made of an electrically conductive material to deliver electrical energy such as monopolar RF, bipolar RF, microwave, or irreversible electroporation (IRE), for example. The electrode 168 may comprises gap setting pads made of a polyimide material, and in one aspect, is made of a durable high-performance polyimide-based plastic known under the tradename VESPEL and manufactured by DuPont or other suitable polyimide, polyimide polymer alloy, or PET (Polyethylene Terephthalate), PEEK (Polyether Ether Ketone), PEKK (Poly Ether Ketone Ketone) polymer alloy, for example. Unless otherwise noted hereinbelow, the clamp arm pads and gap pads described hereinbelow are made of the materials described in this paragraph.

The electrode 168 and the ultrasonic blade 166 are coupled to the generator 133. The generator 133 is configured to drive RF, microwave, or IRE energy to the electrode 168. The generator 133 also is configured to drive an ultrasonic transducer acoustically coupled to the ultrasonic blade 166. In certain implementations, the electrode 168 is one pole of an electrical circuit and the ultrasonic blade 166 is the opposite pole of the electrical circuit. The housing 152 includes a switch 174 to activate the ultrasonic blade 166. The circuit may be contained in the housing 152 or may reside in the generator 133. The surgical device 150 is coupled to the generator 133 via a cable 181. The cable 181 conducts signals for the electrosurgical functions and the ultrasonic transducer.

In various aspects, the surgical device 100 is configured to deliver at least two energy types (e.g., ultrasonic, monopolar RF, bipolar RF, microwave, or irreversible electroporation [IRE]) to tissue located in the end-effector 110 between the clamp arm 111 and the ultrasonic blade 116. The housing 102 of the surgical device 100 includes a first activation button switch 126 for activating energy and a second “mode” button switch 130 for selecting an energy mode for the activation button switch. The second button switch 130 is connected to a circuit that uses at least one input parameter to define the energy mode. The input parameter can be modified remotely through connection to a generator or through a software update. The energy mode is displayed on a user interface 128.

In one aspect, the surgical instrument 150 provides mode switching through the on device directional selector “mode” button switch 180. The user can press the mode button switch 180 to toggle through different modes and the colored light on the user interface 178 indicates the selected mode.

According to various aspects of the present disclosure, different modes of operation can be assigned to the surgical device by pressing the “mode” button switch 180, where each time the mode button switch 180 is pressed, or pushed and held, the surgical device 150 toggles through the available modes, which are displayed on the user interface 178. Once a mode is selected, the generator 133 will provide the appropriate generator tone and the surgical device 150 will have a lighted indicator on the user interface 178 to indicate which mode was selected.

In the example illustrated in FIG. 88 , the “mode” selection button switch 180 is placed on the back of the surgical device 150. The location of the “mode” selection button switch 180 is out of the reach of the surgeon's hand holding the surgical device 150 so a second hand is required to change modes. This is intended to prevent inadvertent activation. In order to change modes, a surgeon must use her second hand to intentionally press the mode button switch 180. The lighted indicator on the user interface 178 of the surgical device 150, in addition to generator tones gives the surgeon feedback on which mode is selected.

FIG. 289A shows a first mode selection option where as the mode button switch 180 is pressed to toggled through various modes, colored light indicates the selected mode on the user interface 178.

FIG. 89B shows a second mode selection option where as the mode button switch 180 is pressed to toggle through various modes a screen 182 indicates the selected mode (e.g., LCD, e-ink).

FIG. 89C shows a third mode selection option where as the mode button switch 180 is pressed to toggle through various modes, labelled lights 184 indicate the selected mode.

FIG. 89D shows a fourth mode selection option where as a labeled button switch 186 is pressed to select a mode, when a labeled button switch 180 is selected, it is illuminated to indicate mode selected

In one aspect, the present disclosure provides a combination ultrasonic/bipolar RF energy surgical device comprising energy activation with trigger closure. As more functionality is added to advanced energy surgical devices additional button switches or controls are added to the surgical devices. The additional button switches or controls make these advanced energy surgical devices complicated and difficult to use. Additionally, when using an advanced energy surgical device to control bleeding, difficult to use user interfaces or difficult to access capability will cost critical time and attention during a surgical procedure.

According to the present disclosure, monopolar RF energy or advanced bipolar RF energy is activated by closing the trigger by squeezing the trigger past a first closure click to a second activation click and holding closed until energy delivery is ceased by the power source in the generator. Energy also can be immediately reapplied by slightly releasing and re-squeezing the trigger as many times as desired.

FIG. 90 illustrates a surgical device 190 comprising a trigger 196 activation mechanism, according to at least one aspect of the present disclosure. The surgical device 190 comprises a housing 192 defining a handle 194 in the form of a pistol grip. The housing 192 comprises a trigger 196 which when squeezed is received into the internal space defined by the handle 194. The housing 192 is coupled to an end-effector through a shaft 198, which is rotatable by a knob 202. The surgical device 190 is coupled to a generator 206 via a cable 204. The cable 204 conducts signals for the electrosurgical functions and the ultrasonic transducer.

The trigger 196 is configured to operate a clamp arm portion of an end-effector and to trigger electrosurgical energy, thus eliminating the activation button switch 126, 176 shown in FIGS. 86-88 . The trigger 196 closes to a first audible and tactile click to close the jaws for grasping tissue and further closes to a second audible and tactile click to activate electrosurgical energy such as monopolar or bipolar RF. Microwave, or IRE energy. The full sequence is completed by activating the front button switch which cuts using ultrasonic energy.

Procedure for operating the surgical device 190: squeeze the trigger 196 to a first audible and tactile click; verify targeted tissue in jaws; activate RF energy by further squeezing the trigger 196 to a second audible and tactile click until end tone is heard; cut by pressing ultrasonic front switch 200 until tissue divides.

Modified procedure for operating the surgical instrument 190 for additional capability: activate RF energy with the trigger 196 and hold while simultaneously activation the front button switch 200 to activate the ultrasonic transducer, which will result in simultaneous application of electrosurgical and ultrasonic energy modalities being delivered to the tissue at the same time.

In an alternative implementation, the front button switch 200 for activating ultrasonic energy may be toggled to different speeds via a mode selector on the surgical device 190 or on the power source generator 206.

The surgical instruments 100, 150, 190 and associated algorithms described above in connection with FIGS. 86-90 comprising the end-effectors described in FIGS. 1-85 may be implemented in the following surgical hub system in conjunction with the following generator and modular energy system, for example.

FIG. 91 illustrates an alternative clamp arm comprising a metal clamp jaw, an electrode, a plurality of clamp arm pads, and gap pads, according to at least one aspect of the present disclosure. FIG. 91 illustrates an alternative clamp arm 2900 comprising a metal clamp jaw 2904, an electrode 2906, a plurality of clamp arm pads 2920 extend through holes in the electrode 2906, a gap pad 2930, and a gap pad 2910, according to at least one aspect of the present disclosure. The electrode 2906 is attached to the metal jaw 2906 at weld locations 2908. The electrode 2906 wraps around the metal clamp jaw 2904 and electrode 2906 can deflect. The gap pad 2910 has a top PI layer 2912 and a bottom elastomer layer 2914 for pressure control that is attached directly to the metal clamp jaw 2904. The clamp arm pads 2920 are attached directly to the metal clamp jaw 2904 and are composite pads with a high pressure center zone 2922 made of PTFE for reduced heat and an outer zone 2924 made of PI for electrode 2906 deflection.

In one aspect, the combination ultrasonic/bipolar RF energy surgical device is configured to operate within a surgical hub system. FIG. 92 is a surgical system 3102 comprising a surgical hub 3106 paired with a visualization system 3108, a robotic system 3110, and an intelligent instrument 3112, in accordance with at least one aspect of the present disclosure. Referring now to FIG. 92 , the hub 3106 is depicted in communication with a visualization system 3108, a robotic system 3110, and a handheld intelligent surgical instrument 3112 configured in a similar manner to the surgical instruments 100, 150, 190 as described in FIGS. 86-91 . The hub 3106 includes a hub display 3135, an imaging module 3138, a generator module 3140, a communication module 3130, a processor module 3132, and a storage array 3134. In certain aspects, as illustrated in FIG. 92 , the hub 3106 further includes a smoke evacuation module 3126 and/or a suction/irrigation module 3128.

During a surgical procedure, energy application to tissue, for sealing and/or cutting, is generally associated with smoke evacuation, suction of excess fluid, and/or irrigation of the tissue. Fluid, power, and/or data lines from different sources are often entangled during the surgical procedure. Valuable time can be lost addressing this issue during a surgical procedure. Detangling the lines may necessitate disconnecting the lines from their respective modules, which may require resetting the modules. The hub modular enclosure 3136 offers a unified environment for managing the power, data, and fluid lines, which reduces the frequency of entanglement between such lines.

Aspects of the present disclosure present a surgical hub for use in a surgical procedure that involves energy application to tissue at a surgical site. The surgical hub includes a hub enclosure and a combo generator module slidably receivable in a docking station of the hub enclosure. The docking station includes data and power contacts. The combo generator module includes two or more of an ultrasonic energy generator component, a bipolar RF energy generator component, and a monopolar RF energy generator component that are housed in a single unit. In one aspect, the combo generator module also includes a smoke evacuation component, at least one energy delivery cable for connecting the combo generator module to a surgical instrument, at least one smoke evacuation component configured to evacuate smoke, fluid, and/or particulates generated by the application of therapeutic energy to the tissue, and a fluid line extending from the remote surgical site to the smoke evacuation component.

In one aspect, the fluid line is a first fluid line and a second fluid line extends from the remote surgical site to a suction and irrigation module slidably received in the hub enclosure. In one aspect, the hub enclosure comprises a fluid interface.

Certain surgical procedures may require the application of more than one energy type to the tissue. One energy type may be more beneficial for cutting the tissue, while another different energy type may be more beneficial for sealing the tissue. For example, a bipolar generator can be used to seal the tissue while an ultrasonic generator can be used to cut the sealed tissue. Aspects of the present disclosure present a solution where a hub modular enclosure 136 is configured to accommodate different generators, and facilitate an interactive communication therebetween. One of the advantages of the hub modular enclosure 136 is enabling the quick removal and/or replacement of various modules.

Aspects of the present disclosure present a modular surgical enclosure for use in a surgical procedure that involves energy application to tissue. The modular surgical enclosure includes a first energy-generator module, configured to generate a first energy for application to the tissue, and a first docking station comprising a first docking port that includes first data and power contacts, wherein the first energy-generator module is slidably movable into an electrical engagement with the power and data contacts and wherein the first energy-generator module is slidably movable out of the electrical engagement with the first power and data contacts,

Further to the above, the modular surgical enclosure also includes a second energy-generator module configured to generate a second energy, different than the first energy, for application to the tissue, and a second docking station comprising a second docking port that includes second data and power contacts, wherein the second energy-generator module is slidably movable into an electrical engagement with the power and data contacts, and wherein the second energy-generator module is slidably movable out of the electrical engagement with the second power and data contacts.

In addition, the modular surgical enclosure also includes a communication bus between the first docking port and the second docking port, configured to facilitate communication between the first energy-generator module and the second energy-generator module.

In one aspect, the present disclosure provides a generator configured to drive the combination ultrasonic/bipolar RF energy surgical device. FIG. 93 illustrates an example of a generator 3900, in accordance with at least one aspect of the present disclosure. As shown in FIG. 93 , the generator 3900 is one form of a generator configured to couple to a surgical instrument 100, 150, 190 as described in FIGS. 86-91 , and further configured to execute adaptive ultrasonic and electrosurgical control algorithms in a surgical data network comprising a modular communication hub as shown in FIG. 92 . The generator 3900 is configured to deliver multiple energy modalities to a surgical instrument. The generator 3900 provides RF and ultrasonic signals for delivering energy to a surgical instrument either independently or simultaneously. The RF and ultrasonic signals may be provided alone or in combination and may be provided simultaneously. As noted above, at least one generator output can deliver multiple energy modalities (e.g., ultrasonic, bipolar or monopolar RF, irreversible and/or reversible electroporation, and/or microwave energy, among others) through a single port, and these signals can be delivered separately or simultaneously to the end effector to treat tissue. The generator 3900 comprises a processor 3902 coupled to a waveform generator 3904. The processor 3902 and waveform generator 3904 are configured to generate a variety of signal waveforms based on information stored in a memory coupled to the processor 3902, not shown for clarity of disclosure. The digital information associated with a waveform is provided to the waveform generator 3904 which includes one or more DAC circuits to convert the digital input into an analog output. The analog output is fed to an amplifier 3906 for signal conditioning and amplification. The conditioned and amplified output of the amplifier 3906 is coupled to a power transformer 3908. The signals are coupled across the power transformer 3908 to the secondary side, which is in the patient isolation side. A first signal of a first energy modality is provided to the surgical instrument between the terminals labeled ENERGY1 and RETURN. A second signal of a second energy modality is coupled across a capacitor 3910 and is provided to the surgical instrument between the terminals labeled ENERGY2 and RETURN. It will be appreciated that more than two energy modalities may be output and thus the subscript “n” may be used to designate that up to n ENERGYn terminals may be provided, where n is a positive integer greater than 1. It also will be appreciated that up to “n” return paths RETURNn may be provided without departing from the scope of the present disclosure.

A first voltage sensing circuit 3912 is coupled across the terminals labeled ENERGY1 and the RETURN path to measure the output voltage therebetween. A second voltage sensing circuit 3924 is coupled across the terminals labeled ENERGY2 and the RETURN path to measure the output voltage therebetween. A current sensing circuit 3914 is disposed in series with the RETURN leg of the secondary side of the power transformer 3908 as shown to measure the output current for either energy modality. If different return paths are provided for each energy modality, then a separate current sensing circuit should be provided in each return leg. The outputs of the first and second voltage sensing circuits 3912, 3924 are provided to respective isolation transformers 3916, 3922 and the output of the current sensing circuit 3914 is provided to another isolation transformer 3918. The outputs of the isolation transformers 3916, 3928, 3922 in the on the primary side of the power transformer 3908 (non-patient isolated side) are provided to a one or more ADC circuit 3926. The digitized output of the ADC circuit 3926 is provided to the processor 3902 for further processing and computation. The output voltages and output current feedback information can be employed to adjust the output voltage and current provided to the surgical instrument and to compute output impedance, among other parameters. Input/output communications between the processor 3902 and patient isolated circuits is provided through an interface circuit 3920. Sensors also may be in electrical communication with the processor 3902 by way of the interface circuit 3920.

In one aspect, the impedance may be determined by the processor 3902 by dividing the output of either the first voltage sensing circuit 3912 coupled across the terminals labeled ENERGY1/RETURN or the second voltage sensing circuit 3924 coupled across the terminals labeled ENERGY2/RETURN by the output of the current sensing circuit 3914 disposed in series with the RETURN leg of the secondary side of the power transformer 3908. The outputs of the first and second voltage sensing circuits 3912, 3924 are provided to separate isolations transformers 3916, 3922 and the output of the current sensing circuit 3914 is provided to another isolation transformer 3916. The digitized voltage and current sensing measurements from the ADC circuit 3926 are provided the processor 3902 for computing impedance. As an example, the first energy modality ENERGY1 may be ultrasonic energy and the second energy modality ENERGY2 may be RF energy. Nevertheless, in addition to ultrasonic and bipolar or monopolar RF energy modalities, other energy modalities include irreversible and/or reversible electroporation and/or microwave energy, among others. Also, although the example illustrated in FIG. 93 shows a single return path RETURN may be provided for two or more energy modalities, in other aspects, multiple return paths RETURNn may be provided for each energy modality ENERGYn. Thus, as described herein, the ultrasonic transducer impedance may be measured by dividing the output of the first voltage sensing circuit 3912 by the current sensing circuit 3914 and the tissue impedance may be measured by dividing the output of the second voltage sensing circuit 3924 by the current sensing circuit 3914.

As shown in FIG. 93 , the generator 3900 comprising at least one output port can include a power transformer 3908 with a single output and with multiple taps to provide power in the form of one or more energy modalities, such as ultrasonic, bipolar or monopolar RF, irreversible and/or reversible electroporation, and/or microwave energy, among others, for example, to the end effector depending on the type of treatment of tissue being performed. For example, the generator 3900 can deliver energy with higher voltage and lower current to drive an ultrasonic transducer, with lower voltage and higher current to drive RF electrodes for sealing tissue, or with a coagulation waveform for spot coagulation using either monopolar or bipolar RF electrosurgical electrodes. The output waveform from the generator 3900 can be steered, switched, or filtered to provide the frequency to the end effector of the surgical instrument. The connection of an ultrasonic transducer to the generator 3900 output would be preferably located between the output labeled ENERGY1 and RETURN as shown in FIG. 92 . In one example, a connection of RF bipolar electrodes to the generator 3900 output would be preferably located between the output labeled ENERGY2 and RETURN. In the case of monopolar output, the preferred connections would be active electrode (e.g., pencil or other probe) to the ENERGY2 output and a suitable return pad connected to the RETURN output.

Additional details are disclosed in U.S. Patent Application Publication No. 2017/0086914, titled TECHNIQUES FOR OPERATING GENERATOR FOR DIGITALLY GENERATING ELECTRICAL SIGNAL WAVEFORMS AND SURGICAL INSTRUMENTS, which published on Mar. 30, 2017, which is herein incorporated by reference in its entirety.

In one aspect, the present disclosure provides a modular energy system configured to drive the combination ultrasonic/bipolar RF energy surgical device. FIG. 94 is a diagram of various modules and other components that are combinable to customize modular energy systems, in accordance with at least one aspect of the present disclosure. FIG. 95A is a first illustrative modular energy system configuration including a header module and a display screen that renders a graphical user interface (GUI) for relaying information regarding modules connected to the header module, in accordance with at least one aspect of the present disclosure. FIG. 95B is the modular energy system shown in FIG. 95A mounted to a cart, in accordance with at least one aspect of the present disclosure.

With reference now to FIGS. 93-95B, ORs everywhere in the world are a tangled web of cords, devices, and people due to the amount of equipment required to perform surgical procedures. Surgical capital equipment tends to be a major contributor to this issue because most surgical capital equipment performs a single, specialized task. Due to their specialized nature and the surgeons' needs to utilize multiple different types of devices during the course of a single surgical procedure, an OR may be forced to be stocked with two or even more pieces of surgical capital equipment, such as energy generators. Each of these pieces of surgical capital equipment must be individually plugged into a power source and may be connected to one or more other devices that are being passed between OR personnel, creating a tangle of cords that must be navigated. Another issue faced in modern ORs is that each of these specialized pieces of surgical capital equipment has its own user interface and must be independently controlled from the other pieces of equipment within the OR. This creates complexity in properly controlling multiple different devices in connection with each other and forces users to be trained on and memorize different types of user interfaces (which may further change based upon the task or surgical procedure being performed, in addition to changing between each piece of capital equipment). This cumbersome, complex process can necessitate the need for even more individuals to be present within the OR and can create danger if multiple devices are not properly controlled in tandem with each other. Therefore, consolidating surgical capital equipment technology into singular systems that are able to flexibly address surgeons' needs to reduce the footprint of surgical capital equipment within ORs would simplify the user experience, reduce the amount of clutter in ORs, and prevent difficulties and dangers associated with simultaneously controlling multiple pieces of capital equipment. Further, making such systems expandable or customizable would allow for new technology to be conveniently incorporated into existing surgical systems, obviating the need to replace entire surgical systems or for OR personnel to learn new user interfaces or equipment controls with each new technology.

A surgical hub can be configured to interchangeably receive a variety of modules, which can in turn interface with surgical devices (e.g., a surgical instrument or a smoke evacuator) or provide various other functions (e.g., communications). In one aspect, a surgical hub can be embodied as a modular energy system 4000, which is illustrated in connection with FIGS. 94-95B. The modular energy system 4000 can include a variety of different modules 4001 that are connectable together in a stacked configuration. In one aspect, the modules 4001 can be both physically and communicably coupled together when stacked or otherwise connected together into a singular assembly. Further, the modules 4001 can be interchangeably connectable together in different combinations or arrangements. In one aspect, each of the modules 4001 can include a consistent or universal array of connectors disposed along their upper and lower surfaces, thereby allowing any module 4001 to be connected to another module 4001 in any arrangement (except that, in some aspects, a particular module type, such as the header module 4002, can be configured to serve as the uppermost module within the stack, for example). In an alternative aspect, the modular energy system 4000 can include a housing that is configured to receive and retain the modules 4001, as is shown in FIG. 92 . The modular energy system 4000 can also include a variety of different components or accessories that are also connectable to or otherwise associatable with the modules 4001. In another aspect, the modular energy system 4000 can be embodied as a generator module 3140, 3900 (FIGS. 92-93 ) of a surgical hub 3106. In yet another aspect, the modular energy system 4000 can be a distinct system from a surgical hub 3106. In such aspects, the modular energy system 4000 can be communicably couplable to a surgical hub 3106 for transmitting and/or receiving data therebetween.

The modular energy system 4000 can be assembled from a variety of different modules 4001, some examples of which are illustrated in FIG. 94 . Each of the different types of modules 4001 can provide different functionality, thereby allowing the modular energy system 4000 to be assembled into different configurations to customize the functions and capabilities of the modular energy system 4000 by customizing the modules 4001 that are included in each modular energy system 4000. The modules 4001 of the modular energy system 4000 can include, for example, a header module 4002 (which can include a display screen 4006), an energy module 4004, a technology module 4040, and a visualization module 4042. In the depicted aspect, the header module 4002 is configured to serve as the top or uppermost module within the modular energy system stack and can thus lack connectors along its top surface. In another aspect, the header module 4002 can be configured to be positioned at the bottom or the lowermost module within the modular energy system stack and can thus lack connectors along its bottom surface. In yet another aspect, the header module 4002 can be configured to be positioned at an intermediate position within the modular energy system stack and can thus include connectors along both its bottom and top surfaces. The header module 4002 can be configured to control the system-wide settings of each module 4001 and component connected thereto through physical controls 4011 thereon and/or a graphical user interface (GUI) 4008 rendered on the display screen 4006. Such settings could include the activation of the modular energy system 4000, the volume of alerts, the footswitch settings, the settings icons, the appearance or configuration of the user interface, the surgeon profile logged into the modular energy system 4000, and/or the type of surgical procedure being performed. The header module 4002 can also be configured to provide communications, processing, and/or power for the modules 4001 that are connected to the header module 4002. The energy module 4004, which can also be referred to as a generator module 3140, 3900 (FIGS. 92-93 ), can be configured to generate one or multiple energy modalities for driving electrosurgical and/or ultrasonic surgical instruments connected thereto, such as is described above in connection with the generator 3900 illustrated in FIG. 93 . The technology module 4040 can be configured to provide additional or expanded control algorithms (e.g., electrosurgical or ultrasonic control algorithms for controlling the energy output of the energy module 4004). The visualization module 4042 can be configured to interface with visualization devices (i.e., scopes) and accordingly provide increased visualization capabilities.

The modular energy system 4000 can further include a variety of accessories 4029 that are connectable to the modules 4001 for controlling the functions thereof or that are otherwise configured to work on conjunction with the modular energy system 4000. The accessories 4029 can include, for example, a single-pedal footswitch 4032, a dual-pedal footswitch 4034, and a cart 4030 for supporting the modular energy system 4000 thereon. The footswitches 4032, 4034 can be configured to control the activation or function of particular energy modalities output by the energy module 4004, for example.

By utilizing modular components, the depicted modular energy system 4000 provides a surgical platform that grows with the availability of technology and is customizable to the needs of the facility and/or surgeons. Further, the modular energy system 4000 supports combo devices (e.g., dual electrosurgical and ultrasonic energy generators) and supports software-driven algorithms for customized tissue effects. Still further, the surgical system architecture reduces the capital footprint by combining multiple technologies critical for surgery into a single system.

The various modular components utilizable in connection with the modular energy system 4000 can include monopolar energy generators, bipolar energy generators, dual electrosurgical/ultrasonic energy generators, display screens, and various other modules and/or other components, some of which are also described above in connection with FIGS. 1-91 .

Referring now to FIG. 95A, the header module 4002 can, in some aspects, include a display screen 4006 that renders a GUI 4008 for relaying information regarding the modules 4001 connected to the header module 4002. In some aspects, the GUI 4008 of the display screen 4006 can provide a consolidated point of control of all of the modules 4001 making up the particular configuration of the modular energy system 4000. In alternative aspects, the header module 4002 can lack the display screen 4006 or the display screen 4006 can be detachably connected to the housing 4010 of the header module 4002. In such aspects, the header module 4002 can be communicably couplable to an external system that is configured to display the information generated by the modules 4001 of the modular energy system 4000. For example, in robotic surgical applications, the modular energy system 4000 can be communicably couplable to a robotic cart or robotic control console, which is configured to display the information generated by the modular energy system 4000 to the operator of the robotic surgical system. As another example, the modular energy system 4000 can be communicably couplable to a mobile display that can be carried or secured to a surgical staff member for viewing thereby. In yet another example, the modular energy system 4000 can be communicably couplable to a surgical hub 4100 or another computer system that can include a display 4104. In aspects utilizing a user interface that is separate from or otherwise distinct from the modular energy system 4000, the user interface can be wirelessly connectable with the modular energy system 4000 as a whole or one or more modules 4001 thereof such that the user interface can display information from the connected modules 4001 thereon.

Referring still to FIG. 95A, the energy module 4004 can include a port assembly 4012 including a number of different ports configured to deliver different energy modalities to corresponding surgical instruments that are connectable thereto. In the particular aspect illustrated in FIGS. 94-95B, the port assembly 4012 includes a bipolar port 4014, a first monopolar port 4016 a, a second monopolar port 4018 b, a neutral electrode port 4018 (to which a monopolar return pad is connectable), and a combination energy port 4020. However, this particular combination of ports is simply provided for illustrative purposes and alternative combinations of ports and/or energy modalities may be possible for the port assembly 4012.

As noted above, the modular energy system 4000 can be assembled into different configurations. Further, the different configurations of the modular energy system 4000 can also be utilizable for different surgical procedure types and/or different tasks. For example, FIGS. 95A and 95B illustrate a first illustrative configuration of the modular energy system 4000 including a header module 4002 (including a display screen 4006) and an energy module 4004 connected together. Such a configuration can be suitable for laparoscopic and open surgical procedures, for example.

FIGS. 96-100 illustrate an example surgical system 10 with ultrasonic and electrosurgical features including any one of the end-effectors, surgical instruments, and generators described herein. FIG. 96 depicts a surgical system 10 including a generator 12 and a surgical instrument 14. The surgical instrument 14 is operatively coupled with the generator 12 via a power cable 16. The generator 12 is operable to power the surgical instrument 14 to deliver ultrasonic energy for cutting tissue, and electrosurgical bipolar RF energy (i.e., therapeutic levels of RF energy) for sealing tissue. In one aspect, the generator 12 is configured to power the surgical instrument 14 to deliver ultrasonic energy and electrosurgical bipolar RF energy simultaneously or independently.

The surgical instrument 14 of the present example comprises a handle assembly 18, a shaft assembly 20 extending distally from the handle assembly 18, and an end effector 22 arranged at a distal end of the shaft assembly 20. The handle assembly 18 comprises a body 24 including a pistol grip 26 and energy control buttons 28, 30 configured to be manipulated by a surgeon. A trigger 32 is coupled to a lower portion of the body 24 and is pivotable toward and away from the pistol grip 26 to selectively actuate the end effector 22, as described in greater detail below. In other suitable variations of the surgical instrument 14, the handle assembly 18 may comprise a scissor grip configuration, for example. An ultrasonic transducer 34 is housed internally within and supported by the body 24. In other configurations, the ultrasonic transducer 34 may be provided externally of the body 24.

As shown in FIGS. 97 and 98 , the end effector 22 includes an ultrasonic blade 36 and a clamp arm 38 configured to selectively pivot toward and away from the ultrasonic blade 36, for clamping tissue therebetween. The ultrasonic blade 36 is acoustically coupled with the ultrasonic transducer 34, which is configured to drive (i.e., vibrate) the ultrasonic blade 36 at ultrasonic frequencies for cutting and/or sealing tissue positioned in contact with the ultrasonic blade 36. The clamp arm 38 is operatively coupled with the trigger 32 such that the clamp arm 38 is configured to pivot toward the ultrasonic blade 36, to a closed position, in response to pivoting of the trigger 32 toward the pistol grip 26. Further, the clamp arm 38 is configured to pivot away from the ultrasonic blade 36, to an open position (see e.g., FIGS. 96-98 ), in response to pivoting of the trigger 32 away from the pistol grip 26. Various suitable ways in which the clamp arm 38 may be coupled with the trigger 32 will be apparent to those of ordinary skill in the art in view of the teachings provided herein. In some versions, one or more resilient members may be incorporated to bias the clamp arm 38 and/or the trigger 32 toward the open position.

A clamp pad 40 is secured to and extends distally along a clamping side of the clamp arm 38, facing the ultrasonic blade 36. The clamp pad 40 is configured to engage and clamp tissue against a corresponding tissue treatment portion of the ultrasonic blade 36 when the clamp arm 38 is actuated to its closed position. At least a clamping-side of the clamp arm 38 provides a first electrode 42, referred to herein as clamp arm electrode 42. Additionally, at least a clamping-side of the ultrasonic blade 36 provides a second electrode 44, referred to herein as a blade electrode 44. The electrodes 42, 44 are configured to apply electrosurgical bipolar RF energy, provided by the generator 12, to tissue electrically coupled with the electrodes 42, 44. The clamp arm electrode 42 may serve as an active electrode while the blade electrode 44 serves as a return electrode, or vice-versa. The surgical instrument 14 may be configured to apply the electrosurgical bipolar RF energy through the electrodes 42, 44 while vibrating the ultrasonic blade 36 at an ultrasonic frequency, before vibrating the ultrasonic blade 36 at an ultrasonic frequency, and/or after vibrating the ultrasonic blade 36 at an ultrasonic frequency.

As shown in FIGS. 96-100 , the shaft assembly 20 extends along a longitudinal axis and includes an outer tube 46, an inner tube 48 received within the outer tube 46, and an ultrasonic waveguide 50 supported within the inner tube 48. As seen best in FIGS. 97-100 , the clamp arm 38 is coupled to distal ends of the inner and outer tubes 46, 48. In particular, the clamp arm 38 includes a pair of proximally extending clevis arms 52 that receive therebetween and pivotably couple to a distal end 54 of the inner tube 48 with a pivot pin 56 received through bores formed in the clevis arms 52 and the distal end 54 of the inner tube 48. The first and second clevis fingers 58 depend downwardly from the clevis arms 52 and pivotably couple to a distal end 60 of the outer tube 46. Specifically, each clevis finger 58 includes a protrusion 62 that is rotatably received within a corresponding opening 64 formed in a sidewall of the distal end 60 of the outer tube 46.

In the present example, the inner tube 48 is longitudinally fixed relative to the handle assembly 18, and the outer tube 46 is configured to translate relative to the inner tube 48 and the handle assembly 18, along the longitudinal axis of the shaft assembly 20. As the outer tube 46 translates distally, the clamp arm 38 pivots about the pivot pin 56 toward its open position. As the outer tube 46 translates proximally, the clamp arm 38 pivots in an opposite direction toward its closed position. A proximal end of the outer tube 46 is operatively coupled with the trigger 32, for example via a linkage assembly, such that actuation of the trigger 32 causes translation of the outer tube 46 relative to the inner tube 48, thereby opening or closing the clamp arm 38. In other suitable configurations not shown herein, the outer tube 46 may be longitudinally fixed and the inner tube 48 may be configured to translate for moving the clamp arm 38 between its open and closed positions.

The shaft assembly 20 and the end effector 22 are configured to rotate together about the longitudinal axis, relative to the handle assembly 18. A retaining pin 66, shown in FIG. 99 , extends transversely through the proximal portions of the outer tube 46, the inner tube 48, and the waveguide 50 to thereby couple these components rotationally relative to one another. In the present example, a rotation knob 68 is provided at a proximal end portion of the shaft assembly 20 to facilitate rotation of the shaft assembly 20, and the end effector 22, relative to the handle assembly 18. The rotation knob 68 is secured rotationally to the shaft assembly 20 with the retaining pin 66, which extends through a proximal collar of the rotation knob 68. It will be appreciated that in other suitable configurations, the rotation knob 68 may be omitted or substituted with alternative rotational actuation structures.

The ultrasonic waveguide 50 is acoustically coupled at its proximal end with the ultrasonic transducer 34, for example by a threaded connection, and at its distal end with the ultrasonic blade 36, as shown in FIG. 100 . The ultrasonic blade 36 is shown formed integrally with the waveguide 50 such that the blade 36 extends distally, directly from the distal end of the waveguide 50. In this manner, the waveguide 50 acoustically couples the ultrasonic transducer 34 with the ultrasonic blade 36, and functions to communicate ultrasonic mechanical vibrations from the transducer 34 to the blade 36. Accordingly, the ultrasonic transducer 34, the waveguide 50, and the ultrasonic blade 36 together define an acoustic assembly. During use, the ultrasonic blade 36 may be positioned in direct contact with tissue, with or without assistive clamping force provided by the clamp arm 38, to impart ultrasonic vibrational energy to the tissue and thereby cut and/or seal the tissue. For example, the blade 36 may cut through tissue clamped between the clamp arm 38 and a first treatment side of the blade 36, or the blade 36 may cut through tissue positioned in contact with an oppositely disposed second treatment side of the blade 36, for example during a “back-cutting” movement. In some variations, the waveguide 50 may amplify the ultrasonic vibrations delivered to the blade 36. Further, the waveguide 50 may include various features operable to control the gain of the vibrations, and/or features suitable to tune the waveguide 50 to a selected resonant frequency. Additional features of the ultrasonic blade 36 and the waveguide 50 are described in greater detail below.

The waveguide 50 is supported within the inner tube 48 by a plurality of nodal support elements 70 positioned along a length of the waveguide 50, as shown in FIGS. 99-100 . Specifically, the nodal support elements 70 are positioned longitudinally along the waveguide 50 at locations corresponding to acoustic nodes defined by the resonant ultrasonic vibrations communicated through the waveguide 50. The nodal support elements 70 may provide structural support to the waveguide 50, and acoustic isolation between the waveguide 50 and the inner and outer tubes 46, 48 of the shaft assembly 20. In variations, the nodal support elements 70 may comprise o-rings. The waveguide 50 is supported at its distal-most acoustic node by a nodal support element in the form of an overmold member 72, shown in FIG. 100 . The waveguide 50 is secured longitudinally and rotationally within the shaft assembly 20 by the retaining pin 66, which passes through a transverse through-bore 74 formed at a proximally arranged acoustic node of the waveguide 50, such as the proximal-most acoustic node, for example.

In the present example, a distal tip 76 of the ultrasonic blade 36 is located at a position corresponding to an anti-node associated with the resonant ultrasonic vibrations communicated through the waveguide 50. Such a configuration enables the acoustic assembly of the instrument 14 to be tuned to a preferred resonant frequency f₀ when the ultrasonic blade 36 is not loaded by tissue. When the ultrasonic transducer 34 is energized by the generator 12 to transmit mechanical vibrations through the waveguide 50 to the blade 36, the distal tip 76 of the blade 36 is caused to oscillate longitudinally in the range of approximately 20 to 120 microns peak-to-peak, for example, and in some instances in the range of approximately 20 to 50 microns, at a predetermined vibratory frequency f₀ of approximately 50 kHz, for example. When the ultrasonic blade 36 is positioned in contact with tissue, the ultrasonic oscillation of the blade 36 may simultaneously sever the tissue and denature the proteins in adjacent tissue cells, thereby providing a coagulative effect with minimal thermal spread.

EXAMPLES

Examples of various aspects of end-effectors and surgical instruments of the present disclosure are provided below. An aspect of the end-effector or surgical instrument may include any one or more than one, and any combination of, the examples described below:

-   -   Example 1. An end-effector, comprising: a clamp arm; and an         ultrasonic blade configured to acoustically couple to an         ultrasonic transducer and to electrically couple to a pole of an         electrical generator; wherein the clamp arm comprises: a clamp         jaw having a proximal end and a distal end, the proximal end         pivotally movable about a pivot point; a cantilever electrode         having a proximal end fixed to the proximal end of the clamp jaw         and a distal end that is free to deflect, the cantilever         electrode defining a surface configured to contact tissue and         apply electrical energy to the tissue in contact therewith,         wherein the cantilever electrode is configured to electrically         couple to an opposite pole of the electrical generator; and a         clamp arm pad fixed to the clamp jaw and having at least a         portion disposed between the clamp jaw and the cantilever         electrode and another portion extending beyond the surface of         the cantilever electrode to contact tissue.     -   Example 2. The end-effector of Example 1, further comprising at         least one gap pad fixed the cantilever electrode to set a gap         between the ultrasonic blade and the cantilever electrode.     -   Example 3. The end-effector of any one of Examples 1-2, wherein         the gap pad is located at a proximal end of the cantilever         electrode.     -   Example 4. The end-effector of any one of Examples 1-3, wherein         the gap pad is made a material having a hardness that is greater         then a hardness of the clamp arm pad such that the gap pad has         longer wear life than the clamp arm pad.     -   Example 5. The end-effector of any one of Examples 1-4, wherein         the clamp arm pad is made of a polymer material and the gap pad         is made of a polyimide material.     -   Example 6. The end-effector of any one of Examples 1-5, wherein         the gap pad is made of a non-compliant material and the clamp         arm pad is made of a compliant material.     -   Example 7. The end-effector of any one of Examples 1-6, wherein         the clamp arm pad is made of a polymer material and the gap pad         is made of a polyimide material.     -   Example 8. The end-effector of any one of Examples 1-7, wherein         the cantilever electrode comprises a gap pad at a proximal end         of the cantilever electrode, a gap pad at a distal end of the         cantilever electrode, and a gap pad located between the proximal         end and the distal end.     -   Example 9. The end-effector of any one of Examples 1-8, wherein         the clamp arm pad comprises a base portion fixedly attached to         the clamp jaw and a plurality of teeth extending from the base         in a direction toward the cantilever electrode.     -   Example 10. The end-effector of any one of Examples 1-9, wherein         the cantilever electrode defines a plurality of apertures.     -   Example 11. The end-effector of any one of Examples 1-10,         further comprising: at least one gap pad fixed the cantilever         electrode to set a gap between the ultrasonic blade and the         cantilever electrode; wherein the clamp arm pad comprises a base         portion fixedly attached to the clamp jaw and a plurality of         teeth extending from the base in a direction toward the         cantilever electrode; and wherein the cantilever electrode         defines a plurality of apertures sized and configured to receive         the at least one gap pad and the plurality of teeth         therethrough.     -   Example 12. The end-effector of any one of Examples 1-11,         wherein the cantilever electrode defines an aperture at the         proximal defining an open end to slidably receive one of the gap         pads.     -   Example 13. The end-effector of any one of Examples 1-12,         further comprising a gap pad located at the distal end of the         cantilever electrode and a gap pad located between the distal         and the proximal end of the cantilever electrode, wherein the         proximal gap pad is sized larger than the distal and the medial         gap pads.     -   Example 14. The end-effector of any one of Examples 1-14,         wherein the proximal end of the cantilever electrode is welded,         brazed, or soldered to the proximal end of the clamp jaw.     -   Example 15. A surgical instrument, comprising: a housing; an         ultrasonic transducer; and an end-effector as defined by         Examples 1-14. The ultrasonic blade is acoustically coupled to         the ultrasonic transducer and electrically couple to a pole of         the electrical generator. The electrode is electrically coupled         to the opposite pole of the electrical generator.     -   Example 16. An end-effector, comprising: a clamp arm; and an         ultrasonic blade configured to acoustically couple to an         ultrasonic transducer and to electrically couple to a pole of an         electrical generator; wherein the clamp arm comprises: a clamp         jaw having a proximal end and a distal end, the proximal end         pivotally movable about a pivot point; a cantilever electrode         having a proximal end fixed to the proximal end of the clamp jaw         and a distal end that is free to deflect, the cantilever         electrode defining a surface configured to contact tissue and         apply electrical energy to the tissue in contact therewith,         wherein the cantilever electrode is configured to electrically         couple to an opposite pole of the electrical generator, and         wherein the cantilever electrode comprises a resilient plug at a         distal end; and a clamp arm pad fixed to the clamp jaw and         having at least a portion disposed between the clamp jaw and the         cantilever electrode and another portion extending beyond the         surface of the cantilever electrode to contact tissue.     -   Example 17. The end-effector of Example 16, wherein the         resilient plug is made of silicone.     -   Example 18. The end-effector of any one of Examples 16-17,         further comprising at least one gap pad fixed the cantilever         electrode to set a gap between the ultrasonic blade and the         cantilever electrode.     -   Example 19. The end-effector of any one of Example 18, wherein         the gap pad is located at a proximal end of the cantilever         electrode.     -   Example 20. The end-effector of any one of Example 19, wherein         the gap pad is made a material having a hardness that is greater         then a hardness of the clamp arm pad such that the gap pad has         longer wear life than the clamp arm pad.     -   Example 21. The end-effector of any one of Example 20, wherein         the clamp arm pad is made of a polymer material and the gap pad         is made of a polyimide material.     -   Example 22. The end-effector of any one of Examples 18-21,         wherein the gap pad is made of a non-compliant material and the         clamp arm pad is made of a compliant material.     -   Example 23. The end-effector of any one of Example 22, wherein         the clamp arm pad is made of a polymer material and the gap pad         is made of a polyimide material.     -   Example 24. The end-effector of any one of Examples 18-23,         wherein the cantilever electrode comprises a gap pad at a         proximal end of the cantilever electrode, a gap pad at a distal         end of the cantilever electrode, and a gap pad located between         the proximal end and the distal end.     -   Example 25. The end-effector of any one of Examples 16-24,         wherein the clamp arm pad comprises a base portion fixedly         attached to the clamp jaw and a plurality of teeth extending         from the base in a direction toward the cantilever electrode.     -   Example 26. The end-effector of any one of Examples 16-25,         wherein the cantilever electrode defines a plurality of         apertures.     -   Example 27. The end-effector of any one of Example 26, further         comprising: at least one gap pad fixed the cantilever electrode         to set a gap between the ultrasonic blade and the cantilever         electrode; wherein the clamp arm pad comprises a base portion         fixedly attached to the clamp jaw and a plurality of teeth         extending from the base in a direction toward the cantilever         electrode; and wherein the cantilever electrode defines a         plurality of apertures sized and configured to receive the at         least one gap pad and the plurality of teeth therethrough.     -   Example 28. The end-effector of any one of Example 27, wherein         the cantilever electrode defines an aperture at the proximal         defining an open end to slidably receive one of the gap pads.     -   Example 29. The end-effector of any one of Example 28, further         comprising a gap pad located at the distal end of the cantilever         electrode and a gap pad located between the distal and the         proximal end of the cantilever electrode, wherein the proximal         gap pad is sized larger than the distal and the medial gap pads.     -   Example 30. The end-effector of any one of Examples 16-29,         wherein the proximal end of the cantilever electrode is welded,         brazed, or soldered to the proximal end of the clamp jaw.     -   Example 31. An end-effector, comprising: a clamp arm; and an         ultrasonic blade configured to acoustically couple to an         ultrasonic transducer and to electrically couple to a pole of an         electrical generator; wherein the clamp arm comprises: a clamp         jaw having a proximal end and a distal end, the proximal end         pivotally movable about a pivot point; a peripheral cantilever         electrode having a proximal end fixed to the proximal end of the         clamp jaw and a distal end that is free to deflect, the         cantilever electrode defining a surface configured to contact         tissue and apply electrical energy to the tissue in contact         therewith, wherein the peripheral cantilever electrode is         configured to electrically couple to an opposite pole of the         electrical generator, and wherein the peripheral cantilever         electrode defines an inner aperture; and a clamp arm pad fixed         to the clamp jaw and having at least a portion disposed between         the clamp jaw and the peripheral cantilever electrode and         another portion extending through the inner aperture beyond the         surface of the peripheral cantilever electrode to contact         tissue.     -   Example 32. The end-effector of Example 31, wherein the         cantilever electrode further comprises a connection pad isolated         from the peripheral cantilever electrode to attach the         peripheral cantilever electrode to a proximal end of the clamp         arm.     -   Example 33. The end-effector of any one of Examples 31-32,         wherein the connection pad sets a gap “x” defined between the         peripheral cantilever electrode and the ultrasonic blade.     -   Example 34. The end-effector of any one of Examples 31-33         wherein the cantilever electrode further comprises a connection         pad extending from the peripheral cantilever electrode to attach         the peripheral cantilever electrode to a proximal end of the         clamp arm.     -   Example 35. The end-effector of any one of Examples 31-34,         wherein the peripheral cantilever electrode comprises an         electrically non-conductive portion to define a space between an         outer of the electrically conductive portion of the peripheral         cantilever electrode and an outer edge of the peripheral         cantilever electrode.     -   Example 36. The end-effector of any one of Example 35, wherein         the peripheral cantilever electrode comprises an electrically         conductive portion that extends the entire distance to the         distal edge of the electrically non-conductive portion.     -   Example 37. An end-effector, comprising: a clamp arm; and an         ultrasonic blade configured to acoustically couple to an         ultrasonic transducer and to electrically couple to a pole of an         electrical generator; wherein the clamp arm comprises: a clamp         jaw having a proximal end and a distal end, the proximal end         pivotally movable about a pivot point; a cantilever electrode         having a proximal end fixed to the proximal end of the clamp jaw         and a distal end that is free to deflect, the cantilever         electrode defining a surface configured to contact tissue and         apply electrical energy to the tissue in contact therewith,         wherein the cantilever electrode is configured to electrically         couple to an opposite pole of the electrical generator, wherein         the cantilever electrode comprises an end-of-life indicator         which can be sensed by the electrical generator to prompt         replacement of the cantilever electrode; and a clamp arm pad         fixed to the clamp jaw and having at least a portion disposed         between the clamp jaw and the cantilever electrode and another         portion extending beyond the surface of the cantilever electrode         to contact tissue.     -   Example 38. The end-effector of Example 37, wherein the         end-of-life indicator comprises a tail made of electrically         conductive cantilever electrode material added to the proximal         end of the cantilever electrode anchor point.     -   Example 39. The end-effector of any one of Example 38, wherein         the tail is configured to deflect towards the ultrasonic blade         as the clamp arm pads and wear resistant pads show wear and tear         use.     -   Example 40. The end-effector of any one of Example 39, wherein         the tail contact with the ultrasonic blade creates an electrical         short circuit that can be detected to trigger an end         notification.     -   Example 41. An end-effector, comprising: a clamp arm; and an         ultrasonic blade configured to acoustically couple to an         ultrasonic transducer and to electrically couple to a pole of an         electrical generator; wherein the clamp arm comprises: a clamp         jaw having a proximal end and a distal end, the proximal end         pivotally movable about a pivot point; a floating electrode         configured to deflect along its entire length, the floating         electrode defining a surface configured to contact tissue and         apply electrical energy to the tissue in contact therewith,         wherein the floating electrode is configured to electrically         couple to an opposite pole of the electrical generator; and a         resilient clamp arm pad fixed to the clamp jaw and having at         least a portion disposed between the clamp jaw and the electrode         and another portion extending beyond the surface of the         electrode to contact tissue.     -   Example 42. The end-effector of Example 41, wherein the floating         electrode is mounted to a spring.     -   Example 43. The end-effector of any one of Examples 41-42,         wherein the clamp arm comprises a plurality of wear resistant         clamp arm pads mounted to the resilient clamp arm pad.     -   Example 44. The end-effector of any one of Examples 41-43,         wherein the resilient clamp arm pad acts as a spring such that         the floating electrode can deflect into the resilient clamp arm         pad and move in a direction toward the clamp jaw.     -   Example 45. The end-effector of any one of Examples 41-44,         further comprising a wear resistant clamp arm pad to set a         tissue gap between the floating electrode and the ultrasonic         blade.     -   Example 46. The end-effector of any one of Examples 41-45,         further comprising a plurality of wear resistant dowel pins         sized and configured to set a tissue gap between the ultrasonic         blade and the floating electrode.     -   Example 47. The end-effector of any one of Example 46, wherein         the dowel pin comprises barb features to prevent the wear         resistant dowel pin from backing out after it is installed in         the clamp arm.     -   Example 48. The end-effector of any one of Example 46, wherein         the dowel pin comprises a pierce feature to prevent the wear         resistant dowel pin from backing out after it is installed in         the clamp arm.     -   Example 49. An end-effector, comprising: a clamp arm; and an         ultrasonic blade configured to acoustically couple to an         ultrasonic transducer and to electrically couple to an opposite         pole of the electrical generator; wherein the clamp arm         comprises: a clamp jaw having a proximal end and a distal end,         the proximal end pivotally movable about a pivot point; a         cantilever electrode having a proximal end fixed to the proximal         end of the clamp jaw and a distal end that is free to deflect,         the cantilever electrode defining a surface configured to         contact tissue and apply electrical energy to the tissue in         contact therewith, wherein the cantilever electrode is         configured to electrically couple to a pole of an electrical         generator, wherein the cantilever electrode comprises a center         pivot configuration to enable the cantilever electrode to rotate         about the center pivot point; and a clamp arm pad fixed to the         clamp jaw and having at least a portion disposed between the         clamp jaw and the cantilever electrode and another portion         extending beyond the surface of the cantilever electrode to         contact tissue.     -   Example 50. The end-effector of Example 49, wherein the         cantilever electrode is formed into a spring element.     -   Example 51. The end-effector of any one of Example 50, wherein         the spring may further comprise strips of metal to form a leaf         spring configuration.     -   Example 52. An end-effector, comprising: a clamp arm; and an         ultrasonic blade configured to acoustically couple to an         ultrasonic transducer and to electrically couple to a pole of an         electrical generator; wherein the clamp arm comprises: a clamp         jaw having a proximal end and a distal end, the proximal end         pivotally movable about a pivot point; a cantilever electrode         having a proximal end fixed to the proximal end of the clamp jaw         and a distal end that is free to deflect, the cantilever         electrode defining a surface configured to contact tissue and         apply electrical energy to the tissue in contact therewith,         wherein the cantilever electrode is configured to electrically         couple to an opposite pole of the electrical generator; a clamp         arm pad fixed to the clamp jaw and having at least a portion         disposed between the clamp jaw and the cantilever electrode and         another portion extending beyond the surface of the cantilever         electrode to contact tissue; and a spring disposed between the         cantilever electrode and the clamp jaw.     -   Example 53. The end-effector of Example 52, wherein the         cantilever electrode comprises wear pads attached to the         cantilever electrode on a side facing the ultrasonic blade.     -   Example 54. The end-effector of any one of Examples 52-53,         wherein the clamp arm further comprises a wave spring element to         support the cantilever electrode.     -   Example 55. The end-effector of any one of Example 54, wherein         the wave spring element is formed integral with the clamp arm         pad to deflect the cantilever electrode in a direction toward         the clamp jaw.     -   Example 56. The end-effector of any one of Example 54, wherein         the wave spring element is positioned between the clamp arm pad         and the cantilever electrode to deflect the cantilever electrode         in a direction toward the clamp jaw.     -   Example 57. The end-effector of any one of Example 54, wherein         the wave spring element is formed integral with the clamp arm         pad to deflect the cantilever electrode in a direction toward         the clamp jaw.     -   Example 58. An end-effector, comprising: a clamp arm; and an         ultrasonic blade configured to acoustically couple to an         ultrasonic transducer and to electrically couple to a pole of an         electrical generator; wherein the clamp arm comprises: a clamp         jaw having a proximal end and a distal end, the proximal end         pivotally movable about a pivot point; a cantilever electrode         having a proximal end fixed to the proximal end of the clamp jaw         and a distal end that is free to deflect, the cantilever         electrode defining a surface configured to contact tissue and         apply electrical energy to the tissue in contact therewith,         wherein the cantilever electrode is configured to electrically         couple to an opposite pole of the electrical generator, wherein         the cantilever electrode is overmolded with an elastomer; and a         clamp arm pad fixed to the clamp jaw and having at least a         portion disposed between the clamp jaw and the cantilever         electrode and another portion extending beyond the surface of         the cantilever electrode to contact tissue.     -   Example 59. The end-effector of Example 58, wherein the         cantilever electrode overmolded with the elastomer provides         uniform compression along a length of the cantilever electrode.     -   Example 60. The end-effector of any one of Examples 58-59,         wherein the cantilever electrode comprises electrical contacts         on lateral portions thereof.     -   Example 61. The end-effector of any one of Examples 58-60,         wherein the spring rate increase as the cantilever electrode         overmolded with the elastomer compresses against the elastomer.     -   Example 62. The end-effector of any one of Examples 58-61,         further comprising overmolded rings or pads on the ultrasonic         blade.     -   Example 63. The end-effector of any one of Examples 58-62, where         the cantilever electrode comprises a diaphragm attached to the         clamp jaw by rigid electrically conductive connections.     -   Example 64. The end-effector of any one of Example 63, wherein         clamp arm pads are disposed on the diaphragm cantilever         electrode.     -   Example 65. The end-effector of any one of Example 63, wherein         the diaphragm cantilever electrode can be formed of a thin         metallic conductor material to flex or deflect the cantilever         electrode.     -   Example 66. The end-effector of any one of Example 63, wherein         the diaphragm cantilever electrode is made in the form of a         ring.     -   Example 67. The end-effector of any one of Examples 58-66,         wherein the cantilever electrode overmolded with the elastomer         comprises ends folded into springs and are in electrical contact         with the clamp jaw.     -   Example 68. An end-effector, comprising: a clamp arm; and an         ultrasonic blade configured to acoustically couple to an         ultrasonic transducer and to electrically couple to a pole of an         electrical generator; wherein the clamp arm comprises: a clamp         jaw having a proximal end and a distal end, the proximal end         pivotally movable about a pivot point; a cantilever electrode         having a proximal end fixed to the proximal end of the clamp jaw         and a distal end that is free to deflect, the cantilever         electrode defining a surface configured to contact tissue and         apply electrical energy to the tissue in contact therewith,         wherein the cantilever electrode is configured to electrically         couple to an opposite pole of the electrical generator; a clamp         arm pad fixed to the clamp jaw and having at least a portion         disposed between the clamp jaw and the cantilever electrode and         another portion extending beyond the surface of the cantilever         electrode to contact tissue; and one or more than one resistor         embedded in the clamp arm pad to sense the height “h” of the         clamp arm pad.     -   Example 69. The end-effector of Example 68, wherein the one or         more than one resistor is configured to melt or wear along with         the clamp arm pad such that a resistance value of the one or         more than one resistor is analogous to the height of the clamp         arm pad.     -   Example 70. A surgical instrument, comprising: a housing; and an         end-effector as defined by Examples 16-69. The ultrasonic blade         is acoustically coupled to the ultrasonic transducer and         electrically couple to a pole of the electrical generator. The         electrode is electrically coupled to the opposite pole of the         electrical generator.     -   Example 71. An end-effector, comprising: a clamp arm; and an         ultrasonic blade configured to acoustically couple to an         ultrasonic transducer and to electrically couple to a pole of an         electrical generator; wherein the clamp arm comprises: a clamp         jaw having a proximal end and a distal end, the proximal end         pivotally movable about a pivot point; a cantilever electrode         plate defining a surface configured to contact tissue and apply         electrical energy to the tissue in contact therewith, wherein         the cantilever electrode plate is configured to electrically         couple to an opposite pole of the electrical generator; and a         clamp arm pad comprising a longitudinally aligned slot         configured to receive the cantilever electrode plate, wherein         the interlocked cantilever electrode plate and clamp arm pad         serve as both the restraining system and the ultrasonic support.     -   Example 72. The end-effector of Example 71, wherein the         longitudinally aligned slot extends from a proximal end through         which the cantilever electrode plate can be advanced without         clamp arm pad material.     -   Example 73. The end-effector of any one of Examples 71-72,         further comprising a tab at a proximal end of the clamp arm pad.     -   Example 74. The end-effector of any one of Example 73, further         comprising a proximal recess at a proximal end of the of the         clamp jaw, wherein the proximal recess is configured to receive         the tab therein to snap fit and lock the clamp arm pad into the         clamp jaw.     -   Example 75. The end-effector of any one of Examples 71-74,         wherein the clamp arm pad comprises a plurality of projections         sized and configured to be received through apertures defined         the cantilever electrode plate.     -   Example 76. A surgical instrument, comprising: a housing; and an         end-effector as defined by Examples 71-75. The ultrasonic blade         is acoustically coupled to the ultrasonic transducer and         electrically couple to a pole of the electrical generator. The         electrode is electrically coupled to the opposite pole of the         electrical generator.     -   Example 77. An end-effector, comprising: a clamp arm; and an         ultrasonic blade configured to acoustically couple to an         ultrasonic transducer and to electrically couple to a pole of an         electrical generator; wherein the clamp arm comprises: a clamp         jaw having a proximal end and a distal end, the proximal end         pivotally movable about a pivot point; a laterally deflectable         cantilever electrode defining a surface configured to contact         tissue and apply electrical energy to the tissue in contact         therewith, wherein the cantilever electrode is configured to         electrically couple to an opposite pole of the electrical         generator; and a clamp arm pad fixed to the clamp jaw and having         at least a portion disposed between the clamp jaw and the         cantilever electrode and another portion extending beyond the         surface of the cantilever electrode to contact tissue.     -   Example 78. The end-effector of Example 77, wherein the         cantilever electrode comprises a proximal end fixed to a         proximal end of the clamp jaw and a distal end that is free to         deflect vertically and laterally by fixating the proximal end         and creating an elastomer connection between a right and left         section of the cantilever electrode which are in electrical         connection with each other.     -   Example 79. The end-effector of any one of Examples 77-78,         wherein the laterally deflectable cantilever electrode is         configured to expand by thermal expansion of the clamp arm pad         due to heat and deformation due to compressive clamp load.     -   Example 80. The end-effector of any one of Examples 77-79,         wherein the laterally deflectable cantilever electrode comprises         a notch defined on a distal end thereof.     -   Example 81. The end-effector of any one of Examples 77-80,         wherein the laterally deflectable cantilever electrode comprises         a vertical stiffening form to secure the deflectable cantilever         electrode to the clamp jaw.     -   Example 82. The end-effector of any one of Examples 77-81,         wherein the laterally deflectable cantilever electrode is a         structural clamping member and is inward facing about the clamp         arm pad.     -   Example 83. The end-effector of any one of Examples 77-82,         wherein the laterally expandable cantilever electrode extends         toward the expanded clamp arm pad when the clamp arm pad         material transitions to a gel-like state at or near 330° C.     -   Example 84. A surgical instrument, comprising: a housing; and an         end-effector as defined by Examples 77-83. The ultrasonic blade         is acoustically coupled to the ultrasonic transducer and         electrically couple to a pole of the electrical generator. The         electrode is electrically coupled to the opposite pole of the         electrical generator.     -   Example 85. An end-effector, comprising: a clamp arm; and an         ultrasonic blade configured to acoustically couple to an         ultrasonic transducer and to electrically couple to a pole of an         electrical generator; wherein the clamp arm comprises: a clamp         jaw having a proximal end and a distal end, the proximal end         pivotally movable about a pivot point; a lattice cushion         defining a longitudinal slot, wherein the lattice cushion acts         as a spring-like element; a flexible cantilever electrode         disposed above the lattice cushion defining a surface configured         to contact tissue and apply electrical energy to the tissue in         contact therewith, wherein the cantilever electrode is         configured to electrically couple to an opposite pole of the         electrical generator; and a clamp arm pad disposed inside the         longitudinal slot defined by the lattice cushion, fixed to the         clamp jaw and having at least a portion disposed between the         clamp jaw and the cantilever electrode and another portion         extending beyond the surface of the cantilever electrode to         contact tissue.     -   Example 86. The end-effector of Example 85, further comprising a         plurality of hard spacers disposed on the flexible cantilever         electrode to set a gap between the flexible cantilever electrode         and the ultrasonic blade.     -   Example 87. The end-effector of any one of Examples 85-86,         wherein in a closed position of the clamp arm, the lattice         cushion applies consistent tissue compression across variable         thickness tissue T1 a, T2 a, T3 a.     -   Example 88. The end-effector of any one of Example 87, wherein         the consistent tissue compression across variable thickness         tissue T1 a, T2 a, T3 a is defined by:

$\frac{T_{1a}}{T_{1b}} = {\frac{T_{2a}}{T_{2b}} = \frac{T_{3a}}{T_{3b}}}$

-   -   Example 88. A surgical instrument, comprising: a housing; and an         end-effector as defined by Examples 85-88. The ultrasonic blade         is acoustically coupled to the ultrasonic transducer and         electrically couple to a pole of the electrical generator. The         electrode is electrically coupled to the opposite pole of the         electrical generator.     -   Example 89. An end-effector, comprising: a clamp arm; and an         ultrasonic blade configured to acoustically couple to an         ultrasonic transducer and to electrically couple to a pole of an         electrical generator; wherein the clamp arm comprises: a clamp         jaw having a proximal end and a distal end, the proximal end         pivotally movable about a pivot point; a clamp arm pad fixed to         the clamp jaw; and a cantilever electrode having a proximal end         fixed to the proximal end of the clamp jaw and a distal end that         is free to deflect, the cantilever electrode defining a surface         configured to contact tissue and apply electrical energy to the         tissue in contact therewith, wherein the cantilever electrode is         configured to electrically couple to an opposite pole of the         electrical generator.     -   Example 90. The end-effector of claim Example 90, further         comprising at least one gap pad fixed the cantilever electrode         to set a gap between the ultrasonic blade and the cantilever         electrode.     -   Example 91. The end-effector of Example 90, wherein the gap pad         is located at a proximal end of the cantilever electrode;         wherein the gap pad is made a material having a hardness that is         greater then a hardness of the clamp arm pad such that the gap         pad has longer wear life than the clamp arm pad; and wherein the         clamp arm pad is made of a polymer material and the gap pad is         made of a polyimide material.     -   Example 92. The end-effector of any one of Examples 90-91,         wherein the gap pad is made of a non-compliant material and the         clamp arm pad is made of a compliant material.     -   Example 93. The end-effector of any one of Examples 90-92,         wherein the cantilever electrode comprises a gap pad at a         proximal end of the cantilever electrode, a gap pad at a distal         end of the cantilever electrode, and a gap pad located between         the proximal end and the distal end.     -   Example 94. The end-effector of any one of Examples 89-93,         wherein the clamp arm pad comprises a base portion fixedly         attached to the clamp jaw and a plurality of teeth extending         from the base in a direction toward the cantilever electrode.     -   Example 95. The end-effector of any one of Examples 89-94,         wherein the cantilever electrode defines a plurality of         apertures.     -   Example 96. The end-effector of any one of Examples 89-95,         wherein the cantilever electrode comprises an end-of-life         indicator which can be sensed by the electrical generator to         prompt replacement of the cantilever electrode; and wherein the         end-of-life indicator comprises a tail made of electrically         conductive electrode material added to the proximal end of the         cantilever electrode anchor point; wherein the tail is         configured to deflect towards the ultrasonic blade as the clamp         arm pads and wear resistant pads show wear and tear use; and         wherein the tail contact with the ultrasonic blade creates an         electrical short circuit that can be detected to trigger an end         notification.     -   Example 97. The end-effector of any one of Examples 89-96,         wherein the cantilever electrode comprises a center pivot         configuration to enable the cantilever electrode to rotate about         the center pivot point.     -   Example 98. The end-effector of any one of Examples 89-97,         wherein the cantilever electrode is formed into a spring         element; and wherein the spring may further comprise strips of         metal to form a leaf spring configuration.     -   Example 99. The end-effector of any one of Examples 89-98,         further comprising a spring disposed between the cantilever         electrode and the clamp jaw.     -   Example 100. The end-effector of claim 98, wherein the         cantilever electrode comprises wear pads attached to the         cantilever electrode on a side facing the ultrasonic blade.     -   Example 101. The end-effector of any one of Examples 89-100,         wherein the clamp arm further comprises a wave spring element to         support the cantilever electrode; wherein the wave spring         element is formed integral with the clamp arm pad to deflect the         cantilever electrode in a direction toward the clamp jaw;         wherein the wave spring element is positioned between the clamp         arm pad and the cantilever electrode to deflect the cantilever         electrode in a direction toward the clamp jaw; and wherein the         wave spring element is formed integral with the clamp arm pad to         deflect the cantilever electrode in a direction toward the clamp         jaw.     -   Example 102. The end-effector of any one of Examples 89-101,         wherein the cantilever electrode is overmolded with an elastomer         to provide uniform compression along a length of the cantilever         electrode; and a clamp arm pad fixed to the clamp jaw and having         at least a portion disposed between the clamp jaw and the         cantilever electrode and another portion extending beyond the         surface of the cantilever electrode to contact tissue.     -   Example 103. The end-effector of Example 102, wherein the         cantilever electrode comprises electrical contacts on lateral         portions thereof.     -   Example 104. The end-effector of any one of Examples 102-103,         wherein the spring rate increase as the cantilever electrode         overmolded with the elastomer compresses against the elastomer.     -   Example 105. The end-effector of any one of Examples 102-104,         wherein the ultrasonic blade comprises overmolded rings or pads.     -   Example 106. The end-effector of any one of Examples 102-105,         where the cantilever electrode comprises a diaphragm attached to         the clamp jaw by rigid electrically conductive connections;         wherein the clamp arm pad is disposed on the diaphragm; and         wherein the diaphragm can be formed of a thin metallic conductor         material to flex or deflect the cantilever electrode.     -   Example 107. The end-effector of any one of Examples 102-106,         wherein the cantilever electrode is overmolded with the         elastomer comprises ends folded into springs and are in         electrical contact with the clamp jaw.     -   Example 108. The end-effector of any one of Examples 89-107,         wherein the clamp arm pad comprises one or more than one         resistor embedded in the clamp arm pad to sense the height “h”         of the clamp arm pad.     -   Example 109. The end-effector of Example 108, wherein the one or         more than one resistor is configured to melt or wear along with         the clamp arm pad such that a resistance value of the one or         more than one resistor is analogous to the height of the clamp         arm pad.     -   Example 110. The end-effector of any one of Examples 89-109,         wherein the cantilever electrode comprises a resilient plug at a         distal end; and the clamp arm pad comprise at least a portion         disposed between the clamp jaw and the cantilever electrode and         another portion extending beyond the surface of the cantilever         electrode to contact tissue.     -   Example 111. An end-effector, comprising: a clamp arm; and an         ultrasonic blade configured to acoustically couple to an         ultrasonic transducer and to electrically couple to a pole of an         electrical generator; wherein the clamp arm comprises: a clamp         jaw having a proximal end and a distal end, the proximal end         pivotally movable about a pivot point; a peripheral cantilever         electrode having a proximal end fixed to the proximal end of the         clamp jaw and a distal end that is free to deflect, the         cantilever electrode defining a surface configured to contact         tissue and apply electrical energy to the tissue in contact         therewith, wherein the peripheral cantilever electrode is         configured to electrically couple to an opposite pole of the         electrical generator, and wherein the peripheral cantilever         electrode defines an inner aperture; and a clamp arm pad fixed         to the clamp jaw and having at least a portion disposed between         the clamp jaw and the peripheral cantilever electrode and         another portion extending through the inner aperture beyond the         surface of the peripheral cantilever electrode to contact         tissue.     -   Example 112. The end-effector of Example 111, wherein the         peripheral cantilever electrode further comprises a connection         pad isolated from the peripheral cantilever electrode to attach         the peripheral cantilever electrode to a proximal end of the         clamp arm.     -   Example 113. The end-effector of any one of Examples 111-112,         wherein the connection pad sets a gap “x” defined between the         peripheral cantilever electrode and the ultrasonic blade.     -   Example 114. The end-effector of any one of Examples 111-113,         wherein the peripheral cantilever electrode further comprises a         connection pad extending from the peripheral cantilever         electrode to attach the peripheral cantilever electrode to a         proximal end of the clamp arm.     -   Example 115. The end-effector of any one of Examples 111-114,         wherein the peripheral cantilever electrode comprises an         electrically non-conductive portion to define a space between an         outer of the electrically conductive portion of the peripheral         cantilever electrode and an outer edge of the peripheral         cantilever electrode.     -   Example 116. An end-effector, comprising: a clamp arm; and an         ultrasonic blade configured to couple to an ultrasonic         transducer and to a pole of an electrical generator; wherein the         clamp arm comprises: a clamp jaw having a proximal end and a         distal end, the proximal end pivotally movable about a pivot         point; a floating cantilever electrode configured to deflect         along its entire length, the floating cantilever electrode         defining a surface configured to contact tissue and apply         electrical energy to the tissue in contact therewith, wherein         the floating cantilever electrode is configured to couple to an         opposite pole of the electrical generator; and a resilient clamp         arm pad fixed to the clamp jaw and having at least a portion         disposed between the clamp jaw and the cantilever electrode and         another portion extending beyond the surface of the cantilever         electrode to contact tissue.     -   Example 117. The end-effector of Example 116, wherein the         floating cantilever electrode is mounted to a spring.     -   Example 118. The end-effector of Example 117, wherein the clamp         arm comprises a plurality of wear resistant clamp arm pads         mounted to the resilient clamp arm pad.     -   Example 119. The end-effector of any one of Examples 116-118,         wherein the resilient clamp arm pad acts as a spring such that         the floating cantilever electrode can deflect into the resilient         clamp arm pad and move in a direction toward the clamp jaw.     -   Example 120. The end-effector of any one of Examples 116-119,         further comprising a wear resistant clamp arm pad to set a         tissue gap between the floating cantilever electrode and the         ultrasonic blade.     -   Example 121. The end-effector of any one Example 116-120,         further comprising a plurality of wear resistant dowel pins         sized and configured to set a tissue gap between the ultrasonic         blade and the floating cantilever electrode; wherein the dowel         pin comprises barb features to prevent the wear resistant dowel         pin from backing out after it is installed in the clamp arm; and         wherein the dowel pin comprises a pierce feature to prevent the         wear resistant dowel pin from backing out after it is installed         in the clamp arm.     -   Example 121. An end-effector, comprising: a clamp arm; and an         ultrasonic blade configured to acoustically couple to an         ultrasonic transducer and to electrically couple to a pole of an         electrical generator; wherein the clamp arm comprises: a clamp         jaw having a proximal end and a distal end, the proximal end         pivotally movable about a pivot point; a interlocked cantilever         electrode plate defining a surface configured to contact tissue         and apply electrical energy to the tissue in contact therewith,         wherein the interlocked cantilever electrode plate is configured         to electrically couple to an opposite pole of the electrical         generator; and a clamp arm pad comprising a longitudinally         aligned slot configured to receive the interlocked cantilever         electrode plate, wherein the interlocked cantilever electrode         plate and clamp arm pad are configured to restrain and support         the ultrasonic blade.     -   Example 122. The end-effector of Example 121, wherein the         longitudinally aligned slot extends from a proximal end through         which the interlocked cantilever electrode plate can be advanced         without clamp arm pad material.     -   Example 123. The end-effector of any of Examples 121-122,         further comprising a tab at a proximal end of the clamp arm pad;         and a proximal recess at a proximal end of the of the clamp jaw,         wherein the proximal recess is configured to receive the tab         therein to snap fit and lock the clamp arm pad into the clamp         jaw.     -   Example 124. The end-effector of any one of Example 121-123,         wherein the clamp arm pad comprises a plurality of projections         sized and configured to be received through apertures defined         the interlocked electrode plate.     -   Example 125. An end-effector, comprising: a clamp arm; and an         ultrasonic blade configured to acoustically couple to an         ultrasonic transducer and to electrically couple to a pole of an         electrical generator; wherein the clamp arm comprises: a clamp         jaw having a proximal end and a distal end, the proximal end         pivotally movable about a pivot point; a laterally deflectable         cantilever electrode defining a surface configured to contact         tissue and apply electrical energy to the tissue in contact         therewith, wherein the laterally deflectable cantilever         electrode is configured to electrically couple to an opposite         pole of the electrical generator; and a clamp arm pad fixed to         the clamp jaw and having at least a portion disposed between the         clamp jaw and the laterally deflectable cantilever electrode and         another portion extending beyond the surface of the laterally         deflectable cantilever electrode to contact tissue.     -   Example 126. The end-effector of Example 125, wherein the         laterally deflectable cantilever electrode comprises a proximal         end fixed to a proximal end of the clamp jaw and a distal end         that is free to deflect vertically and laterally by fixating the         proximal end and creating an elastomer connection between a         right and left section of the laterally deflectable cantilever         electrode which are in electrical connection with each other.     -   Example 127. The end-effector of any one of Examples 125-126,         wherein the laterally deflectable cantilever electrode is         configured to expand by thermal expansion of the clamp arm pad         due to heat and deformation due to compressive clamp load.     -   Example 128. The end-effector of any one of Examples 125-127,         wherein the laterally deflectable cantilever electrode comprises         a notch defined on a distal end thereof.     -   Example 129. The end-effector of any one of Examples 125-128,         wherein the laterally deflectable cantilever electrode comprises         a vertical stiffening form to secure the deflectable cantilever         electrode to the clamp jaw.     -   Example 130. An end-effector, comprising: a clamp arm; and an         ultrasonic blade configured to acoustically couple to an         ultrasonic transducer and to electrically couple to a pole of an         electrical generator; wherein the clamp arm comprises: a clamp         jaw having a proximal end and a distal end, the proximal end         pivotally movable about a pivot point; a lattice cushion         defining a longitudinal slot, wherein the lattice cushion acts         as a spring-like element; a flexible cantilever electrode         disposed above the lattice cushion defining a surface configured         to contact tissue and apply electrical energy to the tissue in         contact therewith, wherein the cantilever electrode is         configured to electrically couple to an opposite pole of the         electrical generator; and a clamp arm pad disposed inside the         longitudinal slot defined by the lattice cushion, fixed to the         clamp jaw and having at least a portion disposed between the         clamp jaw and the cantilever electrode and another portion         extending beyond the surface of the cantilever electrode to         contact tissue.     -   Example 131. The end-effector of Example 130, further comprising         a plurality of hard spacers disposed on the flexible cantilever         electrode to set a gap between the flexible cantilever electrode         and the ultrasonic blade.     -   Example 132. The end-effector of anyone of Examples 130-131,         wherein in a closed position of the clamp arm, the lattice         cushion applies consistent tissue compression across variable         thickness tissue T1 a, T2 a, T3 a; wherein the consistent tissue         compression across variable thickness tissue T1 a, T2 a, T3 a is         defined by:

$\frac{T_{1a}}{T_{1b}} = {\frac{T_{2a}}{T_{2b}} = \frac{T_{3a}}{T_{3b}}}$

-   -   Example 133. A surgical instrument comprising a housing; and an         end-effector as defined by any one of Examples 1-132.

While several forms have been illustrated and described, it is not the intention of Applicant to restrict or limit the scope of the appended claims to such detail. Numerous modifications, variations, changes, substitutions, combinations, and equivalents to those forms may be implemented and will occur to those skilled in the art without departing from the scope of the present disclosure. Moreover, the structure of each element associated with the described forms can be alternatively described as a means for providing the function performed by the element. Also, where materials are disclosed for certain components, other materials may be used. It is therefore to be understood that the foregoing description and the appended claims are intended to cover all such modifications, combinations, and variations as falling within the scope of the disclosed forms. The appended claims are intended to cover all such modifications, variations, changes, substitutions, modifications, and equivalents.

The foregoing detailed description has set forth various forms of the devices and/or processes via the use of block diagrams, flowcharts, and/or examples. Insofar as such block diagrams, flowcharts, and/or examples contain one or more functions and/or operations, it will be understood by those within the art that each function and/or operation within such block diagrams, flowcharts, and/or examples can be implemented, individually and/or collectively, by a wide range of hardware, software, firmware, or virtually any combination thereof. Those skilled in the art will recognize that some aspects of the forms disclosed herein, in whole or in part, can be equivalently implemented in integrated circuits, as one or more computer programs running on one or more computers (e.g., as one or more programs running on one or more computer systems), as one or more programs running on one or more processors (e.g., as one or more programs running on one or more microprocessors), as firmware, or as virtually any combination thereof, and that designing the circuitry and/or writing the code for the software and or firmware would be well within the skill of one of skill in the art in light of this disclosure. In addition, those skilled in the art will appreciate that the mechanisms of the subject matter described herein are capable of being distributed as one or more program products in a variety of forms, and that an illustrative form of the subject matter described herein applies regardless of the particular type of signal bearing medium used to actually carry out the distribution.

Instructions used to program logic to perform various disclosed aspects can be stored within a memory in the system, such as dynamic random access memory (DRAM), cache, flash memory, or other storage. Furthermore, the instructions can be distributed via a network or by way of other computer readable media. Thus a machine-readable medium may include any mechanism for storing or transmitting information in a form readable by a machine (e.g., a computer), but is not limited to, floppy diskettes, optical disks, compact disc, read-only memory (CD-ROMs), and magneto-optical disks, read-only memory (ROMs), random access memory (RAM), erasable programmable read-only memory (EPROM), electrically erasable programmable read-only memory (EEPROM), magnetic or optical cards, flash memory, or a tangible, machine-readable storage used in the transmission of information over the Internet via electrical, optical, acoustical or other forms of propagated signals (e.g., carrier waves, infrared signals, digital signals, etc.). Accordingly, the non-transitory computer-readable medium includes any type of tangible machine-readable medium suitable for storing or transmitting electronic instructions or information in a form readable by a machine (e.g., a computer).

As used in any aspect herein, the term “control circuit” may refer to, for example, hardwired circuitry, programmable circuitry (e.g., a computer processor including one or more individual instruction processing cores, processing unit, processor, microcontroller, microcontroller unit, controller, digital signal processor (DSP), programmable logic device (PLD), programmable logic array (PLA), or field programmable gate array (FPGA)), state machine circuitry, firmware that stores instructions executed by programmable circuitry, and any combination thereof. The control circuit may, collectively or individually, be embodied as circuitry that forms part of a larger system, for example, an integrated circuit (IC), an application-specific integrated circuit (ASIC), a system on-chip (SoC), desktop computers, laptop computers, tablet computers, servers, smart phones, etc. Accordingly, as used herein “control circuit” includes, but is not limited to, electrical circuitry having at least one discrete electrical circuit, electrical circuitry having at least one integrated circuit, electrical circuitry having at least one application specific integrated circuit, electrical circuitry forming a general purpose computing device configured by a computer program (e.g., a general purpose computer configured by a computer program which at least partially carries out processes and/or devices described herein, or a microprocessor configured by a computer program which at least partially carries out processes and/or devices described herein), electrical circuitry forming a memory device (e.g., forms of random access memory), and/or electrical circuitry forming a communications device (e.g., a modem, communications switch, or optical-electrical equipment). Those having skill in the art will recognize that the subject matter described herein may be implemented in an analog or digital fashion or some combination thereof.

As used in any aspect herein, the term “logic” may refer to an app, software, firmware and/or circuitry configured to perform any of the aforementioned operations. Software may be embodied as a software package, code, instructions, instruction sets and/or data recorded on non-transitory computer readable storage medium. Firmware may be embodied as code, instructions or instruction sets and/or data that are hard-coded (e.g., nonvolatile) in memory devices.

As used in any aspect herein, the terms “component,” “system,” “module” and the like can refer to a computer-related entity, either hardware, a combination of hardware and software, software, or software in execution.

As used in any aspect herein, an “algorithm” refers to a self-consistent sequence of steps leading to a desired result, where a “step” refers to a manipulation of physical quantities and/or logic states which may, though need not necessarily, take the form of electrical or magnetic signals capable of being stored, transferred, combined, compared, and otherwise manipulated. It is common usage to refer to these signals as bits, values, elements, symbols, characters, terms, numbers, or the like. These and similar terms may be associated with the appropriate physical quantities and are merely convenient labels applied to these quantities and/or states.

A network may include a packet switched network. The communication devices may be capable of communicating with each other using a selected packet switched network communications protocol. One example communications protocol may include an Ethernet communications protocol which may be capable permitting communication using a Transmission Control Protocol/Internet Protocol (TCP/IP). The Ethernet protocol may comply or be compatible with the Ethernet standard published by the Institute of Electrical and Electronics Engineers (IEEE) titled “IEEE 802.3 Standard”, published in December, 2008 and/or later versions of this standard. Alternatively or additionally, the communication devices may be capable of communicating with each other using an X.25 communications protocol. The X.25 communications protocol may comply or be compatible with a standard promulgated by the International Telecommunication Union-Telecommunication Standardization Sector (ITU-T). Alternatively or additionally, the communication devices may be capable of communicating with each other using a frame relay communications protocol. The frame relay communications protocol may comply or be compatible with a standard promulgated by Consultative Committee for International Telegraph and Telephone (CCITT) and/or the American National Standards Institute (ANSI). Alternatively or additionally, the transceivers may be capable of communicating with each other using an Asynchronous Transfer Mode (ATM) communications protocol. The ATM communications protocol may comply or be compatible with an ATM standard published by the ATM Forum titled “ATM-MPLS Network Interworking 2.0” published August 2001, and/or later versions of this standard. Of course, different and/or after-developed connection-oriented network communication protocols are equally contemplated herein.

Unless specifically stated otherwise as apparent from the foregoing disclosure, it is appreciated that, throughout the foregoing disclosure, discussions using terms such as “processing,” “computing,” “calculating,” “determining,” “displaying,” or the like, refer to the action and processes of a computer system, or similar electronic computing device, that manipulates and transforms data represented as physical (electronic) quantities within the computer system's registers and memories into other data similarly represented as physical quantities within the computer system memories or registers or other such information storage, transmission or display devices.

One or more components may be referred to herein as “configured to,” “configurable to,” “operable/operative to,” “adapted/adaptable,” “able to,” “conformable/conformed to,” etc. Those skilled in the art will recognize that “configured to” can generally encompass active-state components and/or inactive-state components and/or standby-state components, unless context requires otherwise.

The terms “proximal” and “distal” are used herein with reference to a clinician manipulating the handle portion of the surgical instrument. The term “proximal” refers to the portion closest to the clinician and the term “distal” refers to the portion located away from the clinician. It will be further appreciated that, for convenience and clarity, spatial terms such as “vertical”, “horizontal”, “up”, and “down” may be used herein with respect to the drawings. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and/or absolute.

Those skilled in the art will recognize that, in general, terms used herein, and especially in the appended claims (e.g., bodies of the appended claims) are generally intended as “open” terms (e.g., the term “including” should be interpreted as “including but not limited to,” the term “having” should be interpreted as “having at least,” the term “includes” should be interpreted as “includes but is not limited to,” etc.). It will be further understood by those within the art that if a specific number of an introduced claim recitation is intended, such an intent will be explicitly recited in the claim, and in the absence of such recitation no such intent is present. For example, as an aid to understanding, the following appended claims may contain usage of the introductory phrases “at least one” and “one or more” to introduce claim recitations. However, the use of such phrases should not be construed to imply that the introduction of a claim recitation by the indefinite articles “a” or “an” limits any particular claim containing such introduced claim recitation to claims containing only one such recitation, even when the same claim includes the introductory phrases “one or more” or “at least one” and indefinite articles such as “a” or “an” (e.g., “a” and/or “an” should typically be interpreted to mean “at least one” or “one or more”); the same holds true for the use of definite articles used to introduce claim recitations.

In addition, even if a specific number of an introduced claim recitation is explicitly recited, those skilled in the art will recognize that such recitation should typically be interpreted to mean at least the recited number (e.g., the bare recitation of “two recitations,” without other modifiers, typically means at least two recitations, or two or more recitations). Furthermore, in those instances where a convention analogous to “at least one of A, B, and C, etc.” is used, in general such a construction is intended in the sense one having skill in the art would understand the convention (e.g., “a system having at least one of A, B, and C” would include but not be limited to systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and/or A, B, and C together, etc.). In those instances where a convention analogous to “at least one of A, B, or C, etc.” is used, in general such a construction is intended in the sense one having skill in the art would understand the convention (e.g., “a system having at least one of A, B, or C” would include but not be limited to systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and/or A, B, and C together, etc.). It will be further understood by those within the art that typically a disjunctive word and/or phrase presenting two or more alternative terms, whether in the description, claims, or drawings, should be understood to contemplate the possibilities of including one of the terms, either of the terms, or both terms unless context dictates otherwise. For example, the phrase “A or B” will be typically understood to include the possibilities of “A” or “B” or “A and B.”

With respect to the appended claims, those skilled in the art will appreciate that recited operations therein may generally be performed in any order. Also, although various operational flow diagrams are presented in a sequence(s), it should be understood that the various operations may be performed in other orders than those which are illustrated, or may be performed concurrently. Examples of such alternate orderings may include overlapping, interleaved, interrupted, reordered, incremental, preparatory, supplemental, simultaneous, reverse, or other variant orderings, unless context dictates otherwise. Furthermore, terms like “responsive to,” “related to,” or other past-tense adjectives are generally not intended to exclude such variants, unless context dictates otherwise.

It is worthy to note that any reference to “one aspect,” “an aspect,” “an exemplification,” “one exemplification,” and the like means that a particular feature, structure, or characteristic described in connection with the aspect is included in at least one aspect. Thus, appearances of the phrases “in one aspect,” “in an aspect,” “in an exemplification,” and “in one exemplification” in various places throughout the specification are not necessarily all referring to the same aspect. Furthermore, the particular features, structures or characteristics may be combined in any suitable manner in one or more aspects.

Any patent application, patent, non-patent publication, or other disclosure material referred to in this specification and/or listed in any Application Data Sheet is incorporated by reference herein, to the extent that the incorporated materials is not inconsistent herewith. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material.

In summary, numerous benefits have been described which result from employing the concepts described herein. The foregoing description of the one or more forms has been presented for purposes of illustration and description. It is not intended to be exhaustive or limiting to the precise form disclosed. Modifications or variations are possible in light of the above teachings. The one or more forms were chosen and described in order to illustrate principles and practical application to thereby enable one of ordinary skill in the art to utilize the various forms and with various modifications as are suited to the particular use contemplated. It is intended that the claims submitted herewith define the overall scope. 

The invention claimed is:
 1. An end-effector, comprising: a clamp arm comprising a clamp arm pad,wherein the clamp arm pad comprises one or more resistors embedded in the clamp arm pad to sense a height of the clamp arm pad; and an ultrasonic blade configured to acoustically couple to an ultrasonic transducer and to electrically couple to a pole of an electrical generator; wherein the clamp arm comprises: a clamp jaw having a proximal end and a distal end, the proximal end pivotally movable about a pivot point; the clamp arm pad fixed to the clamp jaw; and a cantilever electrode having a proximal end fixed to the proximal end of the clamp jaw and a distal end that is free to deflect, the cantilever electrode defining a surface configured to contact tissue and apply electrical energy to the tissue in contact therewith, wherein the cantilever electrode is configured to electrically couple to an opposite pole of the electrical generator.
 2. The end-effector of claim 1, further comprising at least one gap pad fixed to the cantilever electrode to set a gap between the ultrasonic blade and the cantilever electrode.
 3. The end-effector of claim 2, wherein the at least one gap pad is located at the proximal end of the cantilever electrode, wherein the at least one gap pad is made a material having a hardness that is greater than a hardness of the clamp arm pad such that the at least one gap pad has longer wear life than the clamp arm pad, and wherein the clamp arm pad is made of a polymer material and the at least one gap pad is made of a polyimide material.
 4. The end-effector of claim 2, wherein the at least one gap pad is made of a non-compliant material and the clamp arm pad is made of a compliant material.
 5. The end-effector of claim 2, wherein the cantilever electrode comprises a gap pad of the at least one gap pad at the proximal end of the cantilever electrode, a second gap pad of the at least one gap pad at the distal end of the cantilever electrode, and a third gap pad of the at least one gap pad located between the proximal end of the cantilever electrode and the distal end of the cantilever electrode.
 6. The end-effector of claim 1, wherein the clamp arm pad comprises a base portion fixedly attached to the clamp jaw and a plurality of teeth extending from the base portion in a direction toward the cantilever electrode.
 7. The end-effector of claim 1, wherein the cantilever electrode defines a plurality of apertures.
 8. The end-effector of claim 1, wherein the cantilever electrode comprises a center pivot configuration to enable the cantilever electrode to rotate about the center pivot.
 9. The end-effector of claim 1, wherein the cantilever electrode is formed into a spring element, and wherein the spring element further comprises strips of metal to form a leaf spring configuration.
 10. The end-effector of claim 1, further comprising a spring disposed between the cantilever electrode and the clamp jaw.
 11. The end-effector of claim 9, wherein the cantilever electrode comprises wear pads attached to the cantilever electrode on a side facing the ultrasonic blade.
 12. The end-effector of claim 1, wherein the cantilever electrode is overmolded with an elastomer to provide uniform compression along a length of the cantilever electrode, and the clamp arm pad comprises at least a portion disposed between the clamp jaw and the cantilever electrode and another portion extending beyond the surface of the cantilever electrode that is configured to contact tissue.
 13. The end-effector of claim 12, wherein the cantilever electrode comprises electrical contacts on lateral portions thereof.
 14. The end-effector of claim 12, wherein a spring rate of the cantilever electrode increases as the cantilever electrode overmolded with the elastomer compresses against the elastomer.
 15. The end-effector of claim 12, wherein the ultrasonic blade comprises overmolded rings or pads.
 16. The end-effector of claim 12, where the cantilever electrode comprises a diaphragm attached to the clamp jaw by rigid electrically conductive connections, wherein the clamp arm pad is disposed on the diaphragm, and wherein the diaphragm is formed of a thin metallic conductor material to flex or deflect the cantilever electrode.
 17. The end-effector of claim 12, wherein the cantilever electrode overmolded with the elastomer comprises ends folded into springs and that are in electrical contact with the clamp jaw.
 18. The end-effector of claim 1, wherein the one or more than one resistor is configured to melt or wear along with the clamp arm pad such that a resistance value of the one or more resistors is analogous to the height of the clamp arm pad.
 19. The end-effector of claim 1, wherein the cantilever electrode comprises a resilient plug at the distal end, and wherein the clamp arm pad comprises at least a portion disposed between the clamp jaw and the cantilever electrode and another portion extending beyond the surface of the cantilever electrode to contact tissue.
 20. An end-effector, comprising: a clamp arm; and an ultrasonic blade configured to acoustically couple to an ultrasonic transducer and to electrically couple to a pole of an electrical generator; wherein the clamp arm comprises: a clamp jaw having a proximal end and a distal end, the proximal end pivotally movable about a pivot point; a clamp arm pad fixed to the clamp jaw; and a cantilever electrode having a proximal end fixed to the proximal end of the clamp jaw and a distal end that is free to deflect, the cantilever electrode defining a surface configured to contact tissue and apply electrical energy to the tissue in contact therewith, wherein the cantilever electrode is configured to electrically couple to an opposite pole of the electrical generator; wherein the cantilever electrode is overmolded with an elastomer to provide uniform compression along a length of the cantilever electrode, wherein the clamp arm pad fixed to the clamp jaw comprises at least a portion disposed between the clamp jaw and the cantilever electrode and another portion extending beyond the surface of the cantilever electrode that is configured to contact tissue; wherein the cantilever electrode comprises a diaphragm attached to the clamp jaw by rigid electrically conductive connections, wherein the clamp arm pad is disposed on the diaphragm, and wherein the diaphragm is formed of a thin metallic conductor material to flex or deflect the cantilever electrode.
 21. An end-effector, comprising: a clamp arm; and an ultrasonic blade configured to acoustically couple to an ultrasonic transducer and to electrically couple to a pole of an electrical generator; wherein the clamp arm comprises: a clamp jaw having a proximal end and a distal end, the proximal end pivotally movable about a pivot point; a clamp arm pad fixed to the clamp jaw; and a cantilever electrode having a proximal end fixed to the proximal end of the clamp jaw and a distal end that is free to deflect, the cantilever electrode defining a surface configured to contact tissue and apply electrical energy to the tissue in contact therewith, wherein the cantilever electrode is configured to electrically couple to an opposite pole of the electrical generator; wherein the cantilever electrode is overmolded with an elastomer to provide uniform compression along a length of the cantilever electrode, wherein the clamp arm pad fixed to the clamp jaw comprises at least a portion disposed between the clamp jaw and the cantilever electrode and another portion extending beyond the surface of the cantilever electrode that is configured to contact tissue; and wherein the cantilever electrode overmolded with the elastomer comprises ends folded into springs and that are in electrical contact with the clamp jaw.
 22. An end-effector, comprising: a clamp arm; and an ultrasonic blade configured to acoustically couple to an ultrasonic transducer and to electrically couple to a pole of an electrical generator; wherein the clamp arm comprises: a clamp jaw having a proximal end and a distal end, the proximal end pivotally movable about a pivot point; a clamp arm pad fixed to the clamp jaw; and a cantilever electrode having a proximal end fixed to the proximal end of the clamp jaw and a distal end that is free to deflect, the cantilever electrode defining a surface configured to contact tissue and apply electrical energy to the tissue in contact therewith, wherein the cantilever electrode is configured to electrically couple to an opposite pole of the electrical generator, wherein the cantilever electrode comprises a resilient plug at the distal end, and wherein the clamp arm pad comprises at least a portion disposed between the clamp jaw and the cantilever electrode and another portion extending beyond the surface of the cantilever electrode to contact tissue.
 23. The end-effector of claim 22, further comprising at least one gap pad fixed to the cantilever electrode to set a gap between the ultrasonic blade and the cantilever electrode.
 24. The end-effector of claim 23, wherein the at least one gap pad is located at the proximal end of the cantilever electrode, wherein the at least one gap pad is made a material having a hardness that is greater than a hardness of the clamp arm pad such that the at least one gap pad has longer wear life than the clamp arm pad, and wherein the clamp arm pad is made of a polymer material and the at least one gap pad is made of a polyimide material.
 25. The end-effector of claim 23, wherein the at least one gap pad is made of a non-compliant material and the clamp arm pad is made of a compliant material.
 26. The end-effector of claim 23, wherein the cantilever electrode comprises a gap pad of the at least one gap pad at the proximal end of the cantilever electrode, a second gap pad of the at least one gap pad at the distal end of the cantilever electrode, and a third gap pad of the at least one gap pad located between the proximal end of the cantilever electrode and the distal end of the cantilever electrode.
 27. The end-effector of claim 22, wherein the clamp arm pad comprises a base portion fixedly attached to the clamp jaw and a plurality of teeth extending from the base portion in a direction toward the cantilever electrode.
 28. The end-effector of claim 22, wherein the cantilever electrode defines a plurality of apertures.
 29. The end-effector of claim 22, wherein the cantilever electrode comprises a center pivot configuration to enable the cantilever electrode to rotate about the center pivot.
 30. The end-effector of claim 22, wherein the cantilever electrode is formed into a spring element, and wherein the spring element may further comprise strips of metal to form a leaf spring configuration.
 31. The end-effector of claim 22, further comprising a spring disposed between the cantilever electrode and the clamp jaw.
 32. The end-effector of claim 31, wherein the cantilever electrode comprises wear pads attached to the cantilever electrode on a side facing the ultrasonic blade.
 33. The end-effector of claim 22, wherein the cantilever electrode is overmolded with an elastomer to provide uniform compression along a length of the cantilever electrode.
 34. The end-effector of claim 33, wherein the cantilever electrode comprises electrical contacts on lateral portions thereof.
 35. The end-effector of claim 33, wherein a spring rate of the cantilever electrode increases as the cantilever electrode overmolded with the elastomer compresses against the elastomer.
 36. The end-effector of claim 33, wherein the ultrasonic blade comprises overmolded rings or pads.
 37. The end-effector of claim 33, where the cantilever electrode comprises a diaphragm attached to the clamp jaw by rigid electrically conductive connections, wherein the clamp arm pad is disposed on the diaphragm, and wherein the diaphragm is formed of a thin metallic conductor material to flex or deflect the cantilever electrode.
 38. The end-effector of claim 33, wherein the cantilever electrode overmolded with the elastomer comprises ends folded into springs and that are in electrical contact with the clamp jaw. 